Intraoperative radiotherapy for breast cancer

Abstract

Intra-operative radiotherapy (IORT) as a treatment for breast cancer is a relatively new technique that is designed to be a replacement for whole breast external beam radiotherapy (EBRT) in selected women suitable for breast-conserving therapy. This article reviews twelve reasons for the use of the technique, with a particular emphasis on targeted intra-operative radiotherapy (TARGIT) which uses X-rays generated from a portable device within the operating theatre immediately after the breast tumour (and surrounding margin of healthy tissue) has been removed. The delivery of a single fraction of radiotherapy directly to the tumour bed at the time of surgery, with the capability of adding EBRT at a later date if required (risk-adaptive technique) is discussed in light of recent results from a large multinational randomised controlled trial comparing TARGIT with EBRT. The technique avoids irradiation of normal tissues such as skin, heart, lungs, ribs and spine, and has been shown to improve cosmetic outcome when compared with EBRT. Beneficial aspects to both institutional and societal economics are discussed, together with evidence demonstrating excellent patient satisfaction and quality of life. There is a discussion of the published evidence regarding the use of IORT twice in the same breast (for new primary cancers) and in patients who would never be considered for EBRT because of their special circumstances (such as the frail, the elderly, or those with collagen vascular disease). Finally, there is a discussion of the role of the TARGIT Academy in developing and sustaining high standards in the use of the technique.

Keywords: Early breast cancer; Intrabeam; intra-operative radiotherapy (IORT); radiotherapy; targeted intra-operative radiotherapy (TARGIT).

Figure 1

Simulator for training in the TARGIT Academy. The Intrabeam with applicator has been placed into the tumour bed of the simulator, and a purse-stitch applied. TARGIT, targeted intra-operative radiotherapy.

Figure 2

(A) Hands-on training in progress demonstrating the steps involved to trainees; (B) a close-up view of the simulator with the Intrabeam applicator in place.