TARGIT IORT with Intrabeam radiotherapy system for breast cancer

“The most important benefit of TARGIT for a woman with breast cancer is that it allows her to complete her entire local treatment [lumpectomy and radiation therapy] at the time of her operation, with lower toxicity.” 

What is TARGIT IORT for breast cancer?

  • The TARGIT technique uses the Intrabeam device for delivering precise and timely dose of intraoperative radiotherapy accurately to the tumour bed.
  • An academic insight led to the development of this device through a collaborative effort between University College London and the Photoelectron Corporation in 1990s.
  • It was first used on 2 July 1998 in the Middlesex Hospital, UCL, London. Intrabeam is currently manufactured by Carl Zeiss
  • The Intrabeam TARGIT IORT method has been rigorously tested in the ransomised TARGIT-A trial in which 3451 patients from 33 centres in 11 countries participated. Intrabeam TARGIT IORT given during the cancer operation was compared with the traditional radiation therapy given daily over several weeks after the operation.
  • By 2016, breast cancer centres in over 300 hospitals in 35 countries offer Intrabeam TARGIT IORT to suitable patients
  • Intrabeam TARGIT IORT is available for breast cancer patients in these countries

Plain English Summary of the TARGIT-A trial

  • About 70% of patients with breast cancer are eligible for breast-conserving surgery (a lumpectomy), after which the remaining breast is treated with radiotherapy; this avoids a full mastectomy. Traditionally, external beam radiotherapy (EBRT) is delivered to the entire breast in small doses every day for 3– 6 weeks, necessitating patients to travel to and from the radiotherapy centre every working day. This can be impractical and strenuous.
  • The TARGIT (TARGeted Intraoperative radioTherapy) procedure precisely delivers radiation in a single dose during the lumpectomy operation over 15– 35 minutes, using a ball-shaped device that is placed in the space where the tumour was. This way, unnecessary potentially harmful radiation to healthy tissues (skin, heart, lungs, etc.) is avoided and the areas nearest to the tumour site receive the most radiation. In this way, four-fifths of patients avoid EBRT altogether.
  • The TARGIT-A (TARGeted Intraoperative radioTherapy Alone) trial compared TARGIT with EBRT in 3451 patients who were aged≥ 45 years and found that, when TARGIT is given with lumpectomy, the control of breast cancer is much the same as with EBRT. The chances of being alive without return of cancer in the breast at 5 years were 93.9% with TARGIT during lumpectomy and 92.5% with EBRT. Compared with EBRT, TARGIT had fewer side effects and fewer deaths from heart attacks or other cancers. TARGIT would be less expensive than EBRT, potentially saving the NHS up to £9.1 million a year, without considering the cost savings to patients.
  • Targeted intraoperative radiotherapy during lumpectomy is an effective, safer and less expensive option for eligible patients.
  • Intrabeam TARGIT IORT for breast cancer Plain English Summary of TARGIT-A trial
  • More details about the trial design etc can be found here

Better breast-related quality of life with Intrabeam TARGIT-IORT compared with EBRT

Targeted radiotherapy effective and leads to fewer non-breast-cancer deaths: A meta-analysis of the GEC-ESTRO and the TARGIT-A trial 5 year data

Reduced mortality with targeted radioterapy for early breast cancer – a meta- analysis of randomised trials: an undeniable benefit to patients

Environmental and Social benefits of Intrabeam TARGIT IORT for breast cancer
Video Abstract: https://www.youtube.com/watch?v=uJr4YzZA21k
Press release by the BMJ

Surgical technique video of TARGIT IORT for breast cancer

Screenshot 2014-02-22 15.40.53 iPhone App for helping to choose TARGIT for appropriate breast cancer patients.   Android version

TARGIT literature archive and Some presentations and posters about TARGIT

Pride, Prejudice or Science- attitudes towards the results of the TARGIT-A trial of targeted intraoperative radiotherapy for breast cancer. Click for full text PDF

Worldwide adoption of TARGIT IORT for breast cancer

Recent publications related to TARGIT IORT and the TARGIT trials

Intrabeam TARGIT IORT Targeted intraoperative radiotherapy information to help in shared decision making

Intrabeam TARGIT IORT data collection form fillable

The TARGIT trial office has received its main funding from the Health Technology Assessment programme of the National Institutes of Health Research, Department of Health, UK for the TARGIT-A and TARGIT-B trials

TARGIT ISCTARGIT investigators at the  –  10-year International Steering Committee meeting in 2010

First publication of the main results (2010)

Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W, Keshtgar M, Dewar J, Kraus-Tiefenbacher U, Sutterlin M, Esserman L, Holtveg HM, Roncadin M, Pigorsch S, Metaxas M, Falzon M, Matthews A, Corica T, Williams NR, Baum M. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. The Lancet.  2010 ;376(9735):91-102.

5-year results and first analysis of survival (2013)

Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Keshtgar M, Flyger HL, Massarut S, Alvarado M, Saunders C, Eiermann W, Metaxas M, Sperk E, Sütterlin M, Brown D, Esserman L, Roncadin M, Thompson A, Dewar JA, Holtveg HMR, Pigorsch S, Falzon M, Harris E, Matthews A, Brew-Graves C, Potyka I, Corica T, Williams NR, Baum M. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. The Lancet. 11 November 2013. doi:10.1016/s0140-6736(13)61950-9   Full text PDF  Podcast 

Full final 226 page report of the TARGIT-A trial for the the National Institutes of Health Research, Department of Health, UK (2016)

Vaidya JS, Wenz F, Bulsara M, Tobias JS, Joseph DJ, Saunders C, Brew-Graves C, Potyka I, Morris S, Vaidya HJ, Williams NR, Baum M. An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial). Health Technology Assessment 2016;20(73) TARGIT-A randomised clinical trial of TARGIT IORT using Intrabeam