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. 2016 May 9;6(5):e010703.
doi: 10.1136/bmjopen-2015-010703.

Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT

Nathan J Coombs  1 , Joel M Coombs  2 , Uma J Vaidya  3 , Julian Singer  4 , Max Bulsara  5 , Jeffrey S Tobias  6 , Frederik Wenz  7 , David J Joseph  8 , Douglas A Brown  9 , Richard Rainsbury  10 , Tim Davidson  11 , Douglas J A Adamson  9 , Samuele Massarut  12 , David Morgan  13 , Ingrid Potyka  14 , Tammy Corica  15 , Mary Falzon  16 , Norman Williams  14 , Michael Baum  14 , Jayant S Vaidya  14
Affiliations

Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT

Nathan J Coombs et al. BMJ Open. .

Abstract

Objective: To quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks' course of external beam whole breast radiotherapy (EBRT) treatment.

Setting: (1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT.

Participants: 485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres.

Outcome measures: The shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy.

Methods: Distances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the non-parametric Wilcoxon rank-sum (Mann-Whitney) test.

Results: TARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient).

Conclusions: The use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK.

Trial registration number: ISRCTN34086741; Post-results.

Keywords: Breast cancer; IORT; RADIOTHERAPY; TARGIT; targeted intraoperative radiotherapy.

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Figures

Figure 1
Figure 1
Map of the UK showing the locations of radiotherapy centres with a radius of 13 miles (20 km) drawn around them. Two-thirds (63%) of the UK population live outside of towns that have a radiotherapy centre (data given in online supplementary table S2). Contains OS data © Crown copyright 2016, and reference .
Figure 2
Figure 2
The mean distance travelled (above) and CO2 emissions (below) per patient for the allocated treatment. The error bars show the SE of the mean. (1 mile=1.61 km). EBRT, external beam whole breast radiotherapy.
Figure 3
Figure 3
Mean time travelled by a patient for each allocated treatment. EBRT, external beam whole breast radiotherapy.
Figure 4
Figure 4
Estimated travel that was saved by patients in Swindon and Harlow because they were treated with TARGIT IORT (1 mile=1.61 km).
See this image and copyright information in PMC

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