Breast conserving surgery with targeted intraoperative radiotherapy for the management of ductal carcinoma in situ

Abstract

Background A prospective randomized controlled trial has established the efficacy of targeted intraoperative radiotherapy (TARGIT) in the management of invasive breast cancer treated with breast‐conserving surgery (BCS). The purpose of this analysis is to evaluate the efficacy of TARGIT in the management of ductal carcinoma in situ (DCIS). Methods A prospective nonrandomized trial was designed to evaluate the success of TARGIT in the management of DCIS, as measured by a low risk of requiring additional surgery or radiotherapy and an acceptable local recurrence rate (LRR). Results Fifty‐five patients with DCIS received BCS and TARGIT from November 2007 to March 2017. Median patient age was 57 years (range, 42‐83 years) and median histological lesion size was 14.4 mm (range, 2‐51 mm). Four patients required either re‐excision and/or whole breast irradiation, yielding a rate of additional therapy of 7.3% (4 of 55). Among 46 women administered TARGIT at the time of initial BCS, two local recurrences were observed yielding a 4.3% (2 of 46) LRR at 46 months median follow‐up (range, 4‐116 months). There were no clinically significant adverse events. Conclusions Preliminary evidence indicates TARGIT can be performed with a low risk of requiring additional therapy (7.3%) and an acceptable LRR (4.3%) when administered at the time of BCS.

First Intraoperative Radiation Therapy Center in Africa: First 2 Years in Operation, Including COVID-19 Experiences

“…A low complication rate of 2.8% (three of 107) was noted, and this compared well with that reported by the TARGIT-A trial of 3.3% when using a similar definition of complication rate. 25 Four patients experienced hematomas, each requiring a single guided aspiration, and there was no subsequent accumulation of fluid. One patient experienced fat necrosis, but this softened up gradually over 1 year.…”

“…Although patients presenting with HG-DCIS were not included in the TARGIT-A trial, preliminary research provided evidence that TARGIT is a viable option for patients with DCIS because a low risk of additional therapy (7.3%) and a local recurrence rate of only 4.3% were reported. 25 The Intraoperative Radiotherapy With Electrons (ELIOT) trials assessed the frequency and grade of RT-induced pulmonary fibrosis, comparing patients receiving intraoperative electron radiation therapy (IOERT) with those receiving EBRT; the results showed that 4% of the ELIOT arm versus 46% of the EBRT arm developed pulmonary fibrosis, with a higher risk-adjusted recurrence rate in the EBRT arm. 14 Although this study provides compelling evidence, notable differences from contemporary IORT studies included the use of IOERT equipment and the visual assessment used for the evaluation of fibrosis.…”

Oncoplastic breast‐conserving therapy and intraoperative radiotherapy for management of carcinoma in situ of the breast: A single‐center experience

“…5,6 Limited outcome data and fear of inadequate margins have limited the application of IORT to patients with DCIS. 6,7 Despite the adoption of the Society of Surgical Oncology/ American Society for Radiation…”

“…Prospective studies, including the (TARGeted Intraoperative radioTherapy) TARGIT‐A trial, have demonstrated the safety and efficacy of IORT in early‐stage breast cancer 5,6 . Limited outcome data and fear of inadequate margins have limited the application of IORT to patients with DCIS 6,7 . Despite the adoption of the Society of Surgical Oncology/ American Society for Radiation Oncology/American Society of Clinical Oncology Consensus Guidelines defining adequate margins as ≥2 mm, modern series estimate re‐excision rates to be as high as 40%, with 8% of patients requiring >2 excisions 8‐10 .…”

Vaidya, JS; Vaidya, UJ; Baum, M; Bulsara, M; Joseph, D; Tobias, JS; TARGIT-IORT Global Collaborators, ; (2021) Global adoption of single-shot targeted intraoperative radiotherapy (TARGIT-IORT) to improve breast cancer treatment – better for patients, better for health care systems

“…This example is for someone living in Berkeley, California, USA, for example, and going for radiotherapy at the University of Califoria San Francisco UCSF hospital, the closest radiotherapy centre from this house. This interative tool can be accessed at https://targit.org.uk/travel We believe that wider availability and applicability of TARGIT-IORT should enable many more women to have the choice of having breast conservation when they would otherwise have a mastectomy because they are not able to have conventional radiotherapy [39][40][41][42][43][44][45][46][47][48] . TARGIT-IORT also reduces the cost of providing treatment [49][50][51][52][53][54] .…”