Skip to main content

Advertisement

SpringerLink
Log in

TARGIT-R (Retrospective): North American Experience with Intraoperative Radiation Using Low-Kilovoltage X-Rays for Breast Cancer

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Single-dose intraoperative radiotherapy (IORT) is an emerging treatment for women with early stage breast cancer. The objective of this study was to define the frequency of IORT use, patient selection, and outcomes of patients treated in North America.

Methods

A multi-institutional retrospective registry was created, and 19 institutions using low-kilovoltage IORT for the treatment of breast cancer entered data on patients treated at their institution before July 31, 2013. Patient selection, IORT treatment details, complications, and recurrences were analyzed.

Results

From 2007 to July 31, 2013, a total of 935 women were identified and treated with lumpectomy and IORT. A total of 822 patients had at least 6 months’ follow-up documented and were included in the analysis. The number of IORT cases performed increased significantly over time (p < 0.001). The median patient age was 66.8 years. Most patients had disease that was <2 cm in size (90 %) and was estrogen positive (91 %); most patients had invasive ductal cancer (68 %). Of those who had a sentinel lymph node procedure performed, 89 % had negative sentinel lymph nodes. The types of IORT performed were primary IORT in 79 %, secondary IORT in 7 %, or planned boost in 14 %. Complications were low. At a median follow-up of 23.3 months, crude in-breast recurrence was 2.3 % for all patients treated.

Conclusions

IORT use for the treatment of breast cancer is significantly increasing in North America, and physicians are selecting low-risk patients for this treatment option. Low complication and local recurrence rates support IORT as a treatment option for selected women with early stage breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Early Breast Cancer Trialists’ Collaborative Group, Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.

    Article  Google Scholar 

  2. Liu FF, Shi W, Done SJ, et al. Identification of a low-risk luminal A breast cancer cohort that may not benefit from breast radiotherapy. J Clin Oncol. 2015;33:2035–40.

    Article  PubMed  Google Scholar 

  3. Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM, investigators PI. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16:266–73.

  4. Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  6. Farrow DC, Hunt WC, Samet JM. Geographic variation in the treatment of localized breast cancer. N Engl J Med. 1992;326:1097–101.

    Article  CAS  PubMed  Google Scholar 

  7. Dolan JT, Granchi TS, Miller CC 3rd, Brunicardi FC. Low use of breast conservation surgery in medically indigent populations. Am J Surg. 1999;178:470–4.

    Article  CAS  PubMed  Google Scholar 

  8. Athas WF, Adams-Cameron M, Hunt WC, Amir-Fazli A, Key CR. Travel distance to radiation therapy and receipt of radiotherapy following breast-conserving surgery. J Natl Cancer Inst. 2000;92:269–71.

    Article  CAS  PubMed  Google Scholar 

  9. Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013;368:987–98.

    Article  CAS  PubMed  Google Scholar 

  10. Lind PA, Gagliardi G, Wennberg B, Fornander T. A descriptive study of pulmonary complications after postoperative radiation therapy in node-positive stage II breast cancer. Acta Oncol. 1997;36:509–15.

    Article  CAS  PubMed  Google Scholar 

  11. Blom Goldman U, Svane G, Anderson M, Wennberg B, Lind P. Long-term functional and radiological pulmonary changes after radiation therapy for breast cancer. Acta Oncol. 2014;53:1373–9.

  12. Grantzau T, Mellemkjaer L, Overgaard J. Second primary cancers after adjuvant radiotherapy in early breast cancer patients: a national population based study under the Danish Breast Cancer Cooperative Group (DBCG). Radiother Oncol. 2013;106:42–9.

    Article  PubMed  Google Scholar 

  13. Vaidya JS, Vyas JJ, Chinoy RF, Merchant N, Sharma OP, Mittra I. Multicentricity of breast cancer: whole-organ analysis and clinical implications. Br J Cancer. 1996;74:820–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Vaidya JS, Tobias JS, Baum M, et al. Intraoperative radiotherapy for breast cancer. Lancet Oncol. 2004;5:165–73.

    Article  PubMed  Google Scholar 

  15. Shah C, Badiyan S, Ben Wilkinson J, et al. Treatment efficacy with accelerated partial breast irradiation (APBI): final analysis of the American Society of Breast Surgeons MammoSite((R)) breast brachytherapy registry trial. Ann Surg Oncol. 2013;20:3279–85.

    Article  PubMed  Google Scholar 

  16. Vaidya JS, Joseph DJ, Tobias JS, et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376(9735):91–102.

    Article  PubMed  Google Scholar 

  17. Vaidya JS, Wenz F, Bulsara M, et al. 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. Lancet. 2014;383(9917):603–13.

    Article  PubMed  Google Scholar 

  18. Herskind C, Steil V, Kraus-Tiefenbacher U, Wenz F. Radiobiological aspects of intraoperative radiotherapy (IORT) with isotropic low-energy X rays for early-stage breast cancer. Radiat Res. 2005;163:208–15.

    Article  CAS  PubMed  Google Scholar 

  19. Vaidya JS, Baum M, Tobias JS, et al. Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann Oncol. 2001;12:1075–80.

    Article  CAS  PubMed  Google Scholar 

  20. Vaidya JS, Baum M, Tobias JS, et al. Long-term results of targeted intraoperative radiotherapy (Targit) boost during breast-conserving surgery. Int J Radiat Oncol Biol Phys. 2011;81:1091–7.

    Article  PubMed  Google Scholar 

  21. Grobmyer SR, Lightsey JL, Bryant CM, et al. Low-kilovoltage, single-dose intraoperative radiation therapy for breast cancer: results and impact on a multidisciplinary breast cancer program. J Am Coll Surg. 2013;216:617–23.

    Article  PubMed  Google Scholar 

  22. Elliott RL, DeLand M, Head JF, Elliott MC. Accelerated partial breast irradiation: initial experience with the Intrabeam System. Surg Oncol. 2011;20:73–9.

    Article  CAS  PubMed  Google Scholar 

  23. Deneve JL, Hoefer RA, Jr., Harris EE, Laronga C. Accelerated partial breast irradiation: a review and description of an early North American surgical experience with the intrabeam delivery system. Cancer Control. 2012;19:295–308.

    PubMed  Google Scholar 

  24. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.

    Article  PubMed  Google Scholar 

  25. Belletti B, Vaidya JS, D’Andrea S, et al. Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding. Clin Cancer Res. 2008;14:1325–32.

    Article  CAS  PubMed  Google Scholar 

  26. Keshtgar MR, Williams NR, Bulsara M, et al. Objective assessment of cosmetic outcome after targeted intraoperative radiotherapy in breast cancer: results from a randomised controlled trial. Breast Cancer Res Treat. 2013;140:519–25.

    Article  PubMed  Google Scholar 

  27. Sperk E, Welzel G, Keller A, et al. Late radiation toxicity after intraoperative radiotherapy (IORT) for breast cancer: results from the randomized phase III trial TARGIT A. Breast Cancer Res Treat. 2012;135:253–60.

    Article  PubMed  Google Scholar 

  28. McCormick B, Ottesen RA, Hughes ME, et al. Impact of guideline changes on use or omission of radiation in the elderly with early breast cancer: practice patterns at National Comprehensive Cancer Network institutions. J Am Coll Surg. 2014;219:796–802.

    Article  PubMed  Google Scholar 

  29. Alvarado MD, Mohan AJ, Esserman LJ, et al. Cost-effectiveness analysis of intraoperative radiation therapy for early-stage breast cancer. Ann Surg Oncol. 2013;20:2873–80.

    Article  PubMed  Google Scholar 

  30. Abbott A, Laronga C, Valente SA, et al. A multi-institutional analysis of intraoperative radiotherapy for early breast cancer: does age matter? (abstract). Ann Surg Oncol. 2015;22:22.

    Google Scholar 

  31. Abbott AM, Dossett LA, Loftus L, et al. Intraoperative radiotherapy for early breast cancer and age: clinical characteristics and outcomes. Am J Surg. 2015;210:624–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Supported by the Cleveland Clinic Breast Cancer Research Fund.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Cleveland Clinic, Cleveland, OH, USA

    Stephanie A. Valente DO, FACS, Rahul D. Tendulkar MD, Sheen Cherian MD, Colin O’Rourke MS, Joanne Lyons RN & Stephen R. Grobmyer MD

  2. Summit Medical Center, Emeryville, CA, USA

    Jon M. Greif DO, Lisa Bailey MD & Valery Uhl MD

  3. Northwestern Memorial Hospital, Chicago, IL, USA

    Kevin P. Bethke MD & Eric D. Donnelly MD

  4. Memorial University Medical Center, Savannah, GA, USA

    Ray Rudolph MD & Aaron Pederson MD

  5. Lafayette Surgical Clinic, Lafayette, IN, USA

    Thomas Summer MD

  6. Community Physician Network Breast Care, Community Health Network, Indianapolis, IN, USA

    S. Chace Lottich MD & Darrel L. Ross MD

  7. Moffitt Cancer Center, Tampa, FL, USA

    Christine Laronga MD, Loretta Loftus MD & Andrea M. Abbott MD

  8. Ashikari Breast Center, Dobbs Ferry, NY, USA

    Pond Kelemen MD & Ulrich Hermanto MD

  9. Mercy Medical Center, Baltimore, MD, USA

    Neil B. Friedman MD, Gauri C. Bedi MD & Jennifer E. Joh MD

  10. Trinity Medical Center, Birmingham, AL, USA

    William A. Thompson III MD

  11. The Sentara Dorothy G. Hoefer Comprehensive Breast Center, Newport News, VA, USA

    Richard A. Hoefer MD, Jason P. Wilson MD & Song K. Kang MD

  12. Advocate Good Shepherd Hospital, Barrington, IL, USA

    Barry Rosen MD, James Ruffer MD & Luis Bravo MD

  13. University of California Irvine Medical Center, Irvine, CA, USA

    Alice Police MD

  14. Princess Margaret Cancer Centre, Toronto, ON, Canada

    Jamie M. Escallon MD, Anthony W. Fyles MD & David R. McCready MD

  15. Sutter Cancer Center, Sacramento, CA, USA

    Gregory M. Graves MD, Nitin Rohatgi MD, Joyce A. Eaker MD & Jannine Graves RN

  16. Medstar Georgetown University Hospital, Washington, DC, USA

    Shawna C. Willey MD, Eleni A. Tousimis MD & Brian T. Collins MD

  17. University of Florida, Gainesville, FL, USA

    Christina M. Shaw MD

  18. St. Luke’s University Health Network, Bethlehem, PA, USA

    Lee Riley MD, Nimisha Deb MD, Tricia Kelly MD & David L. Andolino MD

  19. MedStar Washington Hospital Center, Washington, DC, USA

    Marc E. Boisvert MD

  20. Loyola University, Chicago, IL, USA

    William Small Jr. MD

Authors
  1. Stephanie A. Valente DO, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul D. Tendulkar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheen Cherian MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Colin O’Rourke MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jon M. Greif DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lisa Bailey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Valery Uhl MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kevin P. Bethke MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eric D. Donnelly MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ray Rudolph MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Aaron Pederson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Thomas Summer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. S. Chace Lottich MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Darrel L. Ross MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Christine Laronga MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Loretta Loftus MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Andrea M. Abbott MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Pond Kelemen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Ulrich Hermanto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Neil B. Friedman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Gauri C. Bedi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Jennifer E. Joh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. William A. Thompson III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Richard A. Hoefer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Jason P. Wilson MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Song K. Kang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Barry Rosen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. James Ruffer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Luis Bravo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Alice Police MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. Jamie M. Escallon MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. Anthony W. Fyles MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  33. David R. McCready MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  34. Gregory M. Graves MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  35. Nitin Rohatgi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  36. Joyce A. Eaker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  37. Jannine Graves RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  38. Shawna C. Willey MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  39. Eleni A. Tousimis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  40. Brian T. Collins MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  41. Christina M. Shaw MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  42. Lee Riley MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  43. Nimisha Deb MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  44. Tricia Kelly MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  45. David L. Andolino MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  46. Marc E. Boisvert MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  47. Joanne Lyons RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  48. William Small Jr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  49. Stephen R. Grobmyer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Stephanie A. Valente DO, FACS or Stephen R. Grobmyer MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Valente, S.A., Tendulkar, R.D., Cherian, S. et al. TARGIT-R (Retrospective): North American Experience with Intraoperative Radiation Using Low-Kilovoltage X-Rays for Breast Cancer. Ann Surg Oncol 23, 2809–2815 (2016). https://doi.org/10.1245/s10434-016-5240-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5240-1

Keywords

Search

Navigation