Breast Cancer Treatment with TARGIT IORT using the Intrabeam system

Targeted Intraoperative Radiotherapy using Intrabeam system for Breast Cancer

TARGIT IORT uses the Intrbeam radiotherapy system and is an elegant approach of partial breast irradiation (PBI) using intraoperative radiotherapy (IORT) for breast cancer.

 


The TARGIT-A trial  compares risk-adapted  IORT using the TARGIT technique (Intrabeam radiotherapy) with whole breast external beam radiotherapy

  • for patients who are 45 years or older and
  • is designed to test if a risk adjusted approach using a single dose of IORT using TARGIT givessimilar results as the usual radiotherapy over several weeks.
  • This trial has completed recruitment.
  • The first results of the TARGIT-A trial were presented in ASCO 2010 and published in the Lancet in July 2010.
  • Updated analysis of local recurrence and first results for survival were published in the Lancet in November 2013

The TARGIT-B trial compares a tumour bed boost with IORT using the TARGIT technique  vs. conventional external beam radiotherapy tumour bed boost. This is given in addition to whole breast radiotherapy

  • for patients who are younger than 45 years, or have a higher risk of cancer recurrence
  • and is designed to test if giving an intraoperative tumour bed boost using TARGIT is superior to the usual externally given tumour bed boost, both in addition to whole breast radiotherapy.
  • This trial started recruitment in June 2013
  • Please click here to read the details of this trial design

Both these trials are for patients who have a breast conserving surgery i.e.,  wide local excision, or lumpectomy. Breast cancer patients who need a mastectomy are not currently suitable for IORT using the TARGIT technique.

Recent papers about TARGIT IORT using Intrabeam.

 

Targeted Intraoperative Radiotherapy (Targit) for early breast cancer 

This video demonstrates the original description of the operative technique for surgeons and radiation oncologists[1][2]

DISCLAIMER 
[1] [pdf] J. Vaidya, M. Baum, J. Tobias, S. Morgan, and D. D’Souza, “The novel technique of delivering targeted intraoperative radiotherapy (Targit) for early breast cancer,” European Journal of Surgical Oncology, vol. 28, pp. 447-454, 2002.
[Bibtex]
@article{vaidya2002thecancer,
author = "Vaidya, JS and Baum, M and Tobias, JS and Morgan, S and D'Souza, D",
journal = "European Journal of Surgical Oncology",
note = "Journal English Article W B SAUNDERS CO LTD JUN 578CW LONDON Vaidya JS Univ Coll London, Royal Free \\& Univ Coll London Med Sch, Dept Surg, 67-73 Riding House St, London W1W 7EJ, England EUR J SURG ONCOL 24-28 OVAL RD, LONDON NW1 7DX, ENGLAND",
pages = "447--454",
title = "The novel technique of delivering targeted intraoperative radiotherapy (Targit) for early breast cancer",
url = "http://www.ncbi.nlm.nih.gov/pubmed/12099658",
volume = "28",
year = "2002",
abstract = "Aim: We believe that conservative treatment of early breast cancer may not require radiotherapy that encompasses the whole breast in all patients. We have developed a novel therapeutic approach that allows targeted intraoperative radiotherapy (Targit) to be safely and accurately delivered in a standard operating theatre. We are currently recruiting for a randomized trial testing whether Targit can replace the whole 6 weeks of post-operative radiotherapy after breast conserving surgery. Methods: This paper describes the operative technique. It employs a miniature electron-beam-driven X-ray source called INTRABEAM(TM) (PeC) that emits soft X-rays (50 IN) from within the breast. The X-rays are emitted from the tip of a 10 cm x 3.2 mm diameter probe, that is enclosed in a spherical applicator (available in 2.5-5 cm diameter sizes), which in turn is inserted in the tumour bed and intraoperative radiotherapy is delivered in about 25 min. The prescribed dose is 5 and 20 Gy at 1 cm and 0.2 cm respectively, from the tumour bed. Results: The biologically effective dose is 7-53 Gy for alpha/beta = 10 and 20-120 Gy for alpha/beta = 1.5. The quick attenuation of the radiation reduces the damage to normal tissues and allows radiotherapy to be delivered in a standard operating theatre. Tungsten impregnated rubber sheets, cut to size, are placed on the chest wall to protect the heart/lungs and over the wound to stop stray radiation. The skin dose is monitored with thermoluminescent detectors (TLDs). After wide local excision of the tumour and good haemostasis, a spherical applicator is inserted in the tumour bed and the target breast tissues are wrapped around it with a purse-string suture. Thus, true conformation of the target around the applicator source is achieved in real time. Conclusion: As a tumour bed boost, this technique has the potential to reduce local recurrence by avoiding geographical misses and achieving excellent dosimetry. In patients with low risk of local recurrence, it has the potential to replace the full 6 weeks of post-operative radiotherapy with considerable implications to patients and hospitals. (C) 2002 Elsevier Science Ltd. All rights reserved",
issn = "0748-7983",
issue = "4",
keyword = "Breast",
keyword = "BREAST CANCER",
keyword = "BREAST-CANCER",
keyword = "cancer",
keyword = "early breast cancer",
keyword = "Intraoperative Radiotherapy",
keyword = "novel",
keyword = "Radiotherapy",
keyword = "technique",
keyword = "Breast Cancer",
keyword = "Intraoperative radiotherapy",
keyword = "Surgical technique",
keyword = "As",
keyword = "attenuation",
keyword = "BED",
keyword = "Breast",
keyword = "breast conserving surgery",
keyword = "Breast tissue",
keyword = "CM",
keyword = "CO",
keyword = "conformation",
keyword = "conservative",
keyword = "conserving",
keyword = "Damage",
keyword = "Detectors",
keyword = "DEVELOPED",
keyword = "Diameter",
keyword = "dose",
keyword = "Dosimetry",
keyword = "English",
keyword = "EXCISION",
keyword = "haemostasis",
keyword = "Hospital",
keyword = "HOSPITALS",
keyword = "IORT",
keyword = "local",
keyword = "Local Recurrence",
keyword = "Low",
keyword = "May",
keyword = "MED",
keyword = "Methods",
keyword = "MM",
keyword = "NORMAL-TISSUES",
keyword = "PAPER",
keyword = "Patient",
keyword = "patients",
keyword = "PROBE",
keyword = "radiation",
keyword = "randomized",
keyword = "RANDOMIZED TRIAL",
keyword = "RD",
keyword = "Recurrence",
keyword = "Result",
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keyword = "Risk",
keyword = "Royal",
keyword = "Science",
keyword = "size",
keyword = "SIZES",
keyword = "Skin",
keyword = "soft",
keyword = "ST",
keyword = "Standard",
keyword = "SURG",
keyword = "surgery",
keyword = "target",
keyword = "TARGIT",
keyword = "testing",
keyword = "therapeutic",
keyword = "TIME",
keyword = "Tissue",
keyword = "Tissues",
keyword = "treatment",
keyword = "TRIAL",
keyword = "Tumour",
keyword = "TUNGSTEN",
keyword = "WALL",
keyword = "X-ray",
keyword = "X-Rays",
}
[2] [pdf] J. Vaidya, M. Baum, J. Tobias, D. D ‘Souza, S. Naidu, S. Morgan, M. Metexas, K. Harte, A. Sliski, and E. Thomson, “Targeted Intra-operative Radiotherapy: An Innovative Method of Treatment for Early Breast Cancer,” Annals of Oncology, vol. 12, pp. 1075-1080, 2001.
[Bibtex]
@article{vaidya2001targetedcancer,
author = "Vaidya, JS and Baum, M and Tobias, JS and D 'Souza, DP and Naidu, SV and Morgan, S and Metexas, M and Harte, KJ and Sliski, AP and Thomson, E",
journal = "Annals of Oncology",
note = "Journal English Article 12 KLUWER ACADEMIC PUBL *EARL BREAST CANC, 1995, NEW ENGL J MED, V333, P1444; BAUM M, 1997, LANCET, V349, P208; COSGROVE GR, 1997, NEUROSURGERY, V40, P518; DALE RG, 1985, BRIT J RADIOL, V58, P515; DALE RG, 1997, EUR J CANCER, V33, P1707; DENG GR, 1996, SCIENCE, V274, P2057; DOUGLAS RM, 1996, INT J RADIAT ONCOL, V36, P443; FENTIMAN IS, 1996, EUR J CANCER A, V32, P608; FISHER ER, 1992, SEMIN SURG ONCOL, V8, P161; RIBEIRO GG, 1993, CLIN ONCOL, V5, P278; VAIDYA JS, 1996, BRIT J CANCER, V74, P820; VAIDYA JS, 1998, EUR J CANCER, V34, P1143 AUG 467VT DORDRECHT Vaidya JS Univ Coll London, Acad Dept Surg, 67-73 Riding House St, London W1W 7EJ, England ANN ONCOL SPUIBOULEVARD 50, PO BOX 17, 3300 AA DORDRECHT, NETHERLANDS",
pages = "1075--1080",
title = "Targeted Intra-operative Radiotherapy: An Innovative Method of Treatment for Early Breast Cancer",
volume = "12",
year = "2001",
abstract = "Introduction: We believe that conservative treatment of early breast cancer may not require radiotherapy that encompasses the whole breast. We present here the clinico-pathological basis for this view, as well as a novel therapeutic approach that allows intra-operative radiotherapy to be safely and accurately delivered to the target tissues in a standard operating theatre. The rationale: Whole-organ analysis of mastectomy specimens reveals that 80% of occult cancer foci are situated remote from the index quadrant. In contrast, over 90% of local recurrences after breast conservative therapy occur near the original tumour, even when radiotherapy is not given. Therefore, the remote occult cancer foci may be clinically irrelevant and radiotherapy to the index quadrant alone might be sufficient. A novel technique: The Photon Radiosurgery System (PRS) is an ingenious portable electron-beam driven device that can typically deliver intra-operative doses of 5-20 Gy, respectively, to 1 cm and 0.2 cm from the tumour bed over about 22 min. The pliable breast tissue - the target - wraps around the source, providing perfect conformal radiotherapy. Being soft X-rays, the dose attenuates rapidly (alpha similar to1/r(3)), reducing distant damage. Results: In our pilot study of 25 patients (age 30-80 years, T = 0.42-4.0 cm), we replaced the routine post-operative tumour bed boost with targeted intra-operative radiotherapy. There have been no major complications and no patient has developed local recurrence, although the median follow-up time is short, at 24 months. Conclusion: It is safe and feasible to deliver targeted intra- operative radiotherapy (Targit) for early breast cancer. We have begun a randomised trial - the first of its kind - comparing Targit with conventional six-week course of radiotherapy. If proven equivalent in terms of local recurrence and cosmesis, it could eliminate the need for the usual six- week course of post-operative radiotherapy",
issn = "0923-7534",
issue = "8",
keyword = "Breast",
keyword = "BREAST CANCER",
keyword = "Breast cancer/Breast conserving therap",
keyword = "BREAST-CANCER",
keyword = "cancer",
keyword = "early breast cancer",
keyword = "Intra-operative",
keyword = "intraoperative",
keyword = "Intraoperative Radiotherapy",
keyword = "IORT/Pilot/Randomised tria",
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keyword = "CM",
keyword = "COMPLICATION",
keyword = "complications",
keyword = "CONFORMAL RADIOTHERAPY",
keyword = "conservative",
keyword = "Cosmesis",
keyword = "Dale",
keyword = "Damage",
keyword = "DEVELOPED",
keyword = "DEVICE",
keyword = "dose",
keyword = "driven",
keyword = "English",
keyword = "ER",
keyword = "FOLLOW UP",
keyword = "Follow-up",
keyword = "INDEX",
keyword = "IORT",
keyword = "IRRADIATION",
keyword = "local",
keyword = "Local Recurrence",
keyword = "M",
keyword = "mastectomy",
keyword = "May",
keyword = "MED",
keyword = "MULTICENTRICITY",
keyword = "NEED",
keyword = "Netherlands",
keyword = "Neurosurgery",
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keyword = "patients",
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keyword = "SPECIMENS",
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keyword = "TARGET TISSUES",
keyword = "TARGIT",
keyword = "technique",
keyword = "TERM",
keyword = "therapeutic",
keyword = "THERAPIES",
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keyword = "TIME",
keyword = "Tissue",
keyword = "Tissues",
keyword = "TRIAL",
keyword = "Tumour",
keyword = "X-ray",
keyword = "X-Rays",
keyword = "BREAST CANCER",
keyword = "BREAST-CANCER",
keyword = "cancer",
keyword = "early breast cancer",
keyword = "intraoperative",
keyword = "Intraoperative Radiotherapy",
keyword = "Radiotherapy",
keyword = "TARGIT",
keyword = "treatment",
}