Published: 20 August 2020
A pioneering breast cancer therapy requiring just one shot of radiotherapy rather than conventional weeks-long treatment, has proven to be as effective for most women in treating the disease, finds research funded and supported by NIHR.
Results of the large international randomised trial, published in the BMJ, confirm the long-term effectiveness of Targeted Intraoperative Radiotherapy (TARGIT-IORT): a breast cancer treatment which is increasingly available throughout the world.
TARGIT-IORT is delivered immediately after lumpectomy (tumour removal), via a small ball-shaped device placed inside the breast, directly where the cancer had been. The single-dose treatment lasts for around 20 to 30 minutes and replaces the need for extra hospital visits, benefiting both patient safety and well-being.
Researchers compared this technique to conventional external beam radiotherapy (EBRT), delivered from outside the body via a linear accelerator radiotherapy machine. This consists of daily treatment sessions, known as fractions, to the whole breast, over three to six weeks. EBRT is given over a few minutes, but requires 15 to 30 hospital visits, which could be a significant distance from where the patient lives.
The TARGIT-A study, funded by the NIHR’s Health Technology Assessment (HTA) Programme, was led by researchers at University College London and involved 32 hospitals and medical centres in ten countries, including UK, France, Germany, USA and Australia.
2,298 women aged 45 or over with invasive ductal carcinoma (breast cancer) and a tumour of up to 3.5cm in size, were randomly assigned to receive either TARGIT-IORT or the traditional EBRT between 2000 and 2012.
Long-term findings show that eight out of every ten patients given TARGIT-IORT had no need for any further post-operative radiotherapy treatments. There was also no detriment to survival and no increase in the likelihood of the cancer returning.
In addition, with TARGIT-IORT, significantly fewer women died from causes other than breast cancer. Previous studies have shown that TARGIT-IORT has fewer radiation-related side effects compared with conventional whole breast radiotherapy, with less pain, better cosmetic outcome and a better quality of life.
Lead author Jayant Vaidya, a Professor of Surgery and Oncology at UCL, said: “With TARGIT-IORT, women can have their surgery and radiation treatment for breast cancer all at the same time.
“This reduces the amount of time spent in hospital and enables women to recover more quickly, meaning they can get back to their lives more quickly.”
At the five-year follow up, recurrence risk of localised breast cancer was 2.1% for TARGIT-IORT compared to 0.95% for EBRT showing TARGIT-IORT to be non-inferior to EBRT. There were 14 fewer deaths for the TARGIT-IORT group.
Significantly, at long-term follow up (average 8.6 years, maximum 18.9 years) there was no statistically significant difference found in any of the breast cancer outcomes, and a substantial reduction in deaths from causes other than breast cancer with TARGIT-IORT.
Researchers say they hope the treatment can be made more available to patients.
The research was supported by the NIHR University College London Hospitals Biomedical Research Centre and also received funding from Cancer Research UK.
More information is on the NIHR Funding and Awards website.