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Single dose radiotherapy during surgery is as good as conventional radiotherapy for most women with early breast cancer, according to a study led by UK researchers.
They found that, for most women, a single dose of targeted radiotherapy during surgery was just as effective as conventional radiotherapy, which requires several visits to hospital after surgery.
“TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned”
They said results from an earlier report of single-dose targeted intraoperative radiotherapy were promising, but clinicians had been waiting for longer term results before adopting the procedure.
As a result, they compared targeted intraoperative radiotherapy immediately after surgery with conventional radiotherapy, involving repeat doses to the whole breast over several days.
Intraoperative radiotherapy was associated with an 80% chance of avoiding a full course of conventional radiotherapy, fewer side effects and no difference in survival or the cancer returning.
Specifically, the researchers compared the long-term effects of targeted intraoperative radiotherapy (TARGIT-IORT) with conventional whole breast external beam radiotherapy (EBRT).
The new findings are based on 2,298 women, aged 45 or older, who were eligible for breast conservation surgery – lumpectomy – at 32 centres in the UK, Europe, Australia, US and Canada.
Between March 2000, and June 2012, 1,140 women were randomised to receive TARGIT-IORT and 1,158 received EBRT.
TARGIT-IORT was given as a single dose straight after surgery as part of the operation and under the same anaesthetic, while EBRT was given as a standard daily dose for three to six weeks post-surgery.
The long-term results showed that TARGIT-IORT was no worse than EBRT, said the researchers in the British Medical Journal.
After five years of monitoring, the local recurrence risk was 2.11% for TARGIT-IORT compared with 0.95% for EBRT. The difference of 1.16% was not considered clinically significant.
In the first five years after surgery, there were 13 additional local recurrences but 14 fewer deaths with TARGIT-IORT compared with EBRT, said the study authors.
“This latest evidence must now be considered in full by NICE”
Over a longer follow-up period –average 8.6 years – there were no statistically significant differences in local recurrence-free survival, mastectomy-free survival, overall survival and breast cancer deaths.
The study authors said: “For patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long-term efficacy for cancer control and lower non-breast cancer mortality.
“TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned,” said the researchers, who were led by Professor Jayant Vaidya from University College London.
Mia Rosenblatt, associate director of policy and influencing at the charity Breast Cancer Now, said the study findings should now be assessed by the National Institute for Health and Care Excellence (NICE).
“This encouraging research provides further evidence that radiotherapy delivered at the same time as breast-conserving surgery for some women with early breast cancer offers similar outcomes to traditional radiotherapy.”
She noted that the treatment was already available in some areas and could reduce the need for multiple hospital visits and lessen the side-effects experienced.
“This latest evidence must now be considered in full by NICE to understand whether [intraoperative] radiotherapy should be rolled out as an option more widely across the NHS,” she said.