TARGIT-R (Retrospective): North American Experience with Intraoperative Radiation Using Low-Kilovoltage X-Rays for Breast Cancer

Valente, Stephanie A.; Tendulkar, Rahul D.; Cherian, Sheen; O’Rourke, Colin; Greif, Jon M.; Bailey, Lisa; Uhl, Valery; Bethke, Kevin P.; Donnelly, Eric D.; Rudolph, Ray; Pederson, Aaron; Summer, Thomas; Lottich, S. Chace; Ross, Darrel L.; Laronga, Christine; Loftus, Loretta; Abbott, Andrea M.; Kelemen, Pond R.; Hermanto, Ulrich; Friedman, Neil B.; Bedi, Gauri C.; Joh, Jennifer E.; Thompson, W. A.; Hoefer, Richard; Wilson, Jason P.; Kang, Sung-Jun; Rosen, Barry P.; Ruffer, James; Bravo, L.; Escallon, Jamie; Fyles, Anthony; McCready, David R.; Graves, Gregory M.; Rohatgi, Nitin; Eaker, Joyce A.; Graves, Jannine; Willey, Shawna C.; Tousimis, Eleni; Collins, Brian T.; Shaw, Christina; Riley, Lee B.; Deb, Nimisha; Kelly, Tricia; Andolino, David L.; Boisvert, Marc; Lyons, Joanne; Small, William; Grobmyer, Stephen R.

doi:10.1245/s10434-016-5240-1

Cited by 42 publications

(33 citation statements)

References 30 publications

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“…For example, the fact that the largest applicators (4.5 and 5 cm) were utilized in 87% of patients indicates that the surgical resection specimens were unusually large despite the predominance of tumors under 2 cm. In contrast, the average applicator diameter used in the TARGIT‐A trial was 3.5‐4 cm even with a mean tumor size that was similar to that reported by Zur et al Similarly, the 3.5 and 4.0 cm applicators were used in 58% of patients in the TARGIT Retrospective Registry, a U.S. retrospective registry of 935 TARGIT recipients . In addition, in a personal series of 100 recent TARGIT cases, the mean applicator diameter was 3.78 cm.…”

supporting

confidence: 60%

Early complications after intraoperative radiotherapy revisited

Holmes

2017

Journal of Surgical Oncology

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supporting

confidence: 60%

Early complications after intraoperative radiotherapy revisited

Holmes

2017

Journal of Surgical Oncology

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“…The 2% rate of local recurrence is similar to the TARGIT‐A trial, which demonstrated a 3.3% rate of local recurrence with 29 month follow‐up, though this trial included higher risk patients . Similarly, TARGIT‐R, a multi‐institutional retrospective registry, identified a local recurrence rate of 2.3% with 23‐month follow‐up . Similar results have been observed in other institutional series evaluating IORT; Chowdhry et al evaluated 110 patients receiving IORT.…”

Section: Discussionmentioning

confidence: 99%

Outcomes with intraoperative radiation therapy for early‐stage breast cancer

et al. 2020

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Adjuvant radiation therapy has been associated with improved local control following breast‐conserving surgery. Traditionally, treatment has been delivered with whole breast irradiation over 3‐6 weeks or partial breast irradiation over 1‐3 weeks. However, intraoperative radiation therapy (IORT) has emerged as a technique that delivers a single dose of radiotherapy at the time of surgery for early‐stage breast cancers. We report initial outcomes and acute toxicities with intraoperative radiation from a single institution. Patients with DCIS or Stage I‐II breast cancer who underwent lumpectomy and sentinel lymph node biopsy (nodal sampling excluded in some cases) were included. All patients in this analysis were treated with IORT as at the time of surgery, 20 Gy in 1 fraction with 50 kV x‐ray. Patients were treated at a single institution between 2011 and 2019. Follow‐up was per standard institutional protocol. Two hundred and one patients were included in the analysis, with a median follow‐up of 23 months (range: 0‐73 months). Median age was 71 years old. Overall, 4 (2.0%) patients had DCIS, 186 (92.5%) patients had Stage 1 disease, and 11 patients had (5.5%) Stage 2 disease. All patients were estrogen receptor‐positive, 175 (87.9%) progesterone receptor‐positive, and 1 (0.5%) HER2 amplified. The crude rate of local recurrence was 2.0% (n = 4) and distant metastasis rate was 0.5% (n = 1). The rate of arm lymphedema was 0.5% (n = 1) and chronic telangiectasia rate was 1.1% (n = 2). Intraoperative radiation therapy, in a cohort of low‐risk patients, demonstrated low rates of recurrence and reproducibility in a multi‐disciplinary setting. Further follow‐up, analysis of patient satisfaction and cosmesis, and comparison to whole breast irradiation and partial breast techniques is necessary in order to further validate these findings.

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Section: Introductionmentioning

confidence: 99%

“…Single dose intraoperative radiotherapy (IORT) has gained popularity in the United States since the mid-2000s (1), with low complication and in-breast recurrence rates reported in the literature (1)(2)(3). Patients selected for IORT treatment are generally low risk individuals given their older age, smaller tumors, and high rates of estrogen receptor positivity (ER+) (1). The updated American Society for Radiation Oncology (ASTRO) consensus statement on partial breast irradiation delineates specific suitable characteristics (including 50 years of age or older with <2.5 cm screen detected invasive tumors of low or intermediate grade) for patients to be considered for low energy x-ray IORT treatment (3).…”

Section: Introductionmentioning

confidence: 99%

Oncotype testing in patients undergoing intraoperative radiation for breast cancer

et al. 2018

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Oncotype DX recurrence score (RS) predicts risk of distant disease recurrence, and can guide chemotherapy recommendations in hormone positive, human epidermal growth factor 2-negative, early stage breast cancer. The present study aimed to evaluate the pattern of oncotype testing, RS and adjuvant treatment in patients undergoing intraoperative radiotherapy (IORT). Single center prospective data registry was queried for patients receiving IORT between October 2011 and February 2017. Patient demographics, tumor characteristics, RS, systemic therapy and recurrence information were analyzed. A total of 150 women with mean age of 70.8 years were included. The majority had invasive ductal cancer (60.6%) with 1.0 cm average tumor size and no lymph node involvement (99%). Oncotype testing was performed in 36 patients (24.3%). Low risk score (<18) was confirmed in 19 women (53%); intermediate risk score (18-30) in 16 women (44%); and high risk score (>30) in one woman (3%). Patients with RS testing had significantly increased tumor sizes (1.2 vs. 1.0 cm; P<0.001) and were younger (68.5 vs. 71.3 years; P=0.02) compared with those not tested. A total of 4/150 patients (2.6%) received chemotherapy; two received chemotherapy based on RS testing. Based on the current selection criteria for IORT, oncotype testing rarely results in a high-risk score or utilization of chemotherapy for IORT patients. The present study supports selective use of RS testing in IORT patients and confirms that biologically low-risk patients are being selected for IORT based on current guidelines.

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TARGIT-R (Retrospective): North American Experience with Intraoperative Radiation Using Low-Kilovoltage X-Rays for Breast Cancer

Cited by 42 publications

References 30 publications

Early complications after intraoperative radiotherapy revisited

Early complications after intraoperative radiotherapy revisited

Outcomes with intraoperative radiation therapy for early‐stage breast cancer

Oncotype testing in patients undergoing intraoperative radiation for breast cancer

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