TARGIT-A trial

 

Targeted Intraoperative Radiotherapy for Breast Cancer

TARGIT

TARGIT is an elegant approach of partial breast irradiation (PBI) during lumpectomy  for breast cancer.

TARGIT is a special type of intraoperative radiotherapy (IORT)

Please scroll down to access literature about TARGIT  and TARGIT-A and TARGIT-B trials



The TARGIT-A trial is

  1. -for patients who are 45 years or older and

  2. -is designed to test if a risk adjusted approach using a single dose of IORT using TARGIT gives similar results as the usual radiotherapy over several weeks.

  3. -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.

  4. -Please scroll below to see detail of the design


The TARGIT-B trial is

- for patients who are younger than 45 years, or have a higher risk of cancer recurrence

  1. -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.

  2. -This trial starts recruitment in Spring 2013

  3. -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 TARGIT.

  

Recent presentations about TARGIT at international scientific meetings and conferences



March 2013 St Gallen Breast Cancer Conference: Two new posters:


Omitting whole breast radiotherapy does not increase axillary recurrence- data from TARGIT-A trial


Fewer non-breast cancer deaths in TARGIT-A trial -systemic benefit of TARGIT or lack of EBRT toxicity



6 December 2012 (General session 4)

Late breaking plenary presentation at the 2012 San Antonio Breast Cancer Symposium:  TARGIT-A trial: Updated results and first analysis of survival

Click on Thursday, 6 December - then General session 4 - 2nd presentation


IORT for breast cancer at San Antonio Breast Cancer Symposium (for those without Flash)



TARGIT-A trial San Antonio news in ASCO Post  (15 Feb 2013)

If you cannot access this on the original site the single page can be downloaded here

Updated results of the TARGIT-A trial


13 September 2012

TARGIT-A and TARGIT-B trials: Plenary presentation at the ASCO Breast Cancer Symposium, San Francisco


15 March 2012

The TARGIT trials: Audience poll after TARGIT presentation at the Miami Breast Cancer Conference, USA.


7 Nov 2011

TARGIT-A trial results: plenary lecture at the BASO-ACS Annual meeting, Royal College of Surgeons of England, London, UK


29 April 2011

TARGIT gets strong support at American Society of Breast Surgeons meeting, Washington DC, USA


19 March 2011

At the 12th International St.Gallen Breast Cancer Conference, St.Gallen, Switzerland, the consensus panel of 52 experts at the Consensus session on the last day of the conference voted in favour of using intraoperative radiotherapy.


September 2010

A description of the TARGIT-A trial in an interview with eCancer TV at the ESSO meeting  Bordeaux


5 June 2010

The results of the TARGIT-A trial published in The Lancet Online first

BBC news

A brief description of the TARGIT-A trial and its results: Click to read


6 June 2010

Oral presentation at the TARGIT Symposium, ASCO, Chicago, USA


7 June 2010

Poster Discussion, ASCO, Chicago, USA



TARGIT-A trial design


In the randomised TARGIT-A trial, two policies of local radiation treatment are compared

:

Breast cancer patient (>=45 years) suitable for breast conserving surgery


RANDOMISE


                              

 

TARGIT group (A)


Individualised-Risk-Adjusted Radiotherapy

A single dose of TARGIT with Intrabeam (in ~85%)


+


if high risk*

add EBRT (45-50Gy, no boost)


*prespeficied criteria e.g., unsuspected lobular carcinoma, lymphovascular invasion, etc.

       

EBRT group (B)


One-size-fits-all Radiotherapy


Standard 4-6 week course of external beam radiotherapy (EBRT)


40-56Gy in 15-25 fractions


+/-


Tumour bed boost

10-16 G y in 5-8 fractions


             

Eligible patients were recruited at two stages of their treatment in the pragmatic Targit trial:

 

Before the primary surgery

(Prepathology randomisation)

This is the original method of entry into the TARGIT-A trial for a breast cancer patient. Once the decision to do a wide local excision (lumpectomy) is taken, and informed consent obtained, the randomisation takes place before surgery and if randomised to TARGIT, it is delivered to the fresh tumour bed immediately after lumpectomy for breast cancer. If at the postoperative pathology review, it is felt that they have a particularly high risk of local recurrence especially in other quadrants (e.g., EIC, extensive LVI or nodal metastases, etc) then external beam radiotherapy can be added- all as part of the experimental arm of the trial.

































After the primary surgery

(Postpathology randomisation)

This mode of entry into the trial is particularly suitable if the excision of the cancer has already been performed. Then randomisation Targit trial can be performed after the primary surgery (lumpectomy or wide local excision) and they can have a single session intraoperative radiotherapy as a day-case operation .





























 

 



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 his device through a collaborative effort between University College London and the industry. It was first used in July 1998 in the Middlesex Hospital, UCL, London.


The TARGIT trial office has received its main funding from the Health Technology Assessment programme of the National Institutes of Health Research, UK.


 

Targit-A trial recruited from 33 international centres from 10 countries (UK, USA, Germany, Italy, France Poland , Switzerland, Denmark, Canada and Australia) and 3451 patients were randomly allocated from 24 March 2000 until the trial closed on 25 June 2012. (Click to see the map).


 

 

Visit: The TARGIT trial Blog





Targeted intraoperative radiotherapy Literature


[NOTE: these papers can be downloaded strictly for personal use only. This site is maintained by Dr Jayant S Vaidya ]


            Pathological and biological rationale of

           partial breast irradiation (PBI) and the basis of the Targit Trial

1995    Hongkong International Cancer Congress

1996    British Journal of Cancer

1997    The Lancet 

 

            Could MRI be useful to select patients for breast conserving surgery?

1998    The Lancet (1)

1998    The Lancet (2)  

 

           The Core trial Protocol of the Targit Trial

1999    The Lancet


            The UK Pilot Study of intraoperative radiation therapy:

            the first full paper about Targit

2001    Annals of Oncology

 

            The surgical technique of targeted intraoperative radiotherapy

            (TARGIT) for early breast cancer treatment

            as used in the Targit trial

2002    European Journal of Surgical Oncology

2002    Surgical Technique Video 


           A possible one-stop out patient treatment for small breast cancers

2002    The Lancet

  

            PhD Thesis of Jayant S Vaidya

2002    University College London PhD Thesis

  

           Some publicity

2000    BBC Tomorrow’s World

2001     Lancet Oncology News

2002    Time Magazine

2003    Reader’s Digest

2006    Reader’s Digest

  

            2003 San Antonio Breast Cancer Symposium

              30-minute invited presentation about the Targit trial

2003    click here - this works

2003    Flash (SABCS Website)- not live any more.

            Poster discussion about cosmetic results of

            the (Targit) intraoperative radiation therapy boost cases

2003    Cosmetic Outcome

  

            Acute and Late Toxicity data about the Targit approach.

2004    ANZ Journal of Surgical Oncology

2005    Oncologie

2005    Tumori

2006    Int J Rad Oncol Biol Phys 

 

            Reviews, Editorial, Viewpoint

2004    Lancet Oncology

2004    British Journal of Radiology

2005    Seminas in Radiation Oncology

2006    Clinical Oncology

2006    The Breast

2007    Nature Clinical Practice Oncology

2008    Annals of New York Academy of Sciences

 

            Book Chapters  

2003    Recent Advances in Surgery

2006    Accelerated Partial Breast Irradiation (1st Edition)

2009    Accelerated Partial Breast Irradiation (2nd Edition)

  

            Radiobiology of Targeted intraoperation radiation therapy (TARGIT) 

            Mathematical Modelling of breast cancer growth, recurrence

            and intra-operative radiotherapy (IORT) 

2005    Radiation Research 

2005    Cancer Research UK Award Poster

2006    Journal of Theoretical Biology

2007    Journal of Theoretical Biology


            Targit under Local Anaesthetic 

2006    World Journal of Surgical Oncology

 

            Targit boost :- results in a very low recurrence

2006    International Journal or Radiation Oncology Biology Physics

2008    American Society of Clinical Oncology (ASCO)

2010    International Journal or Radiation Oncology Biology Physics 

               5-yr actuarial = 1.73%  - half the expected recurrence rate

            Novel effects of TARGIT on tumour micro-environment

2008    Clinical Cancer Research

2009    International Journal of Radiation Oncology Biology Physics