Breast Cancer: Intraoperative vs Whole Breast Radiotherapy

Prof Jayant S Vaidya PhD Clinical Trials Group, Division of Surgery and Interventional Science University College London, London, Interview with:
Prof Jayant S Vaidya PhD
Clinical Trials Group, Division of Surgery and Interventional Science
University College London, London, UK What are the main findings of the study?

Dr. Vaidya: The main findings are

  • a) these are longer term results that have confirmed our original publication in 201
  • (b) We found that when TARGIT intraoperative radiotherapy is given at the time of lumpectomy for breast cancer, the local control and survival from breast cancer is similar to several weeks of whole breast radiotherapy
  • c) we also found that with TARGIT there are significantly fewer deaths from other causes – i.e., fewer deaths from cardiovascular causes and other cancers Were any of the findings unexpected?

Dr. Vaidya: The findings about local control and survival from breast cancer were expected. We had anticipated some benefit from avoiding the side effects of radiotherapy of normal organs (heart, lungs etc) but we were pleasantly surprised that this difference was so clearly apparent – this is perhaps because there are so few deaths from breast cancer, that deaths from other causes have become very important and any effect on these because of treatments has so much more impact. It is now well known that cardiac toxicity of radiation can be see within the first 5 years after radiation so really it is not surprising that we have seen this. What should clinicians and patients take away from your report?

Dr. Vaidya: Clinicians and patients should digest these results and consider this option of using TARGIT during lumpectomy for suitable patients, within a risk-adapted approach. Health policy makers should start considering how this can be rolled out to suitable patients. What recommendations do you have for future research as a result of this study?

Dr. Vaidya: We have found that TARGIT given to the fresh tumour bed modifies the tumour microenvironment that is not conducive to tumour growth and spread – which may contribute to it success. Further investigation into this phenomenon may find new ways of treating cancer. Also, we have recently launched the TARGIT-B trial in more advanced breast cancers  to assess whether a TARGIT tumour bed boost is superior to routine externally delivered tumour bed boost.


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
Prof Jayant S Vaidya PhD,Prof Frederik Wenz MD,Prof Max Bulsara PhD,Prof Jeffrey S Tobias FRCR,Prof David J Joseph FRACR,Prof Mohammed Keshtgar PhD,Henrik L Flyger MD,Samuele Massarut MD,Michael Alvarado MD,Prof Christobel Saunders FRACS,Prof Wolfgang Eiermann MD,Marinos Metaxas PhD,Elena Sperk MD,Prof Marc Sütterlin MD,Douglas Brown FRCS,Prof Laura Esserman MD,Mario Roncadin MD,Prof Alastair Thompson FRCS,Prof John A Dewar FRCR,Helle M R Holtveg MD,Steffi Pigorsch MD,Mary Falzon FRCPath,Eleanor Harris MD,April Matthews BSc,Chris Brew-Graves MSc,Ingrid Potyka PhD,Tammy Corica BSc,Norman R Williams PhD,Prof Michael Baum MD,on behalf of the TARGIT trialists’ group
The Lancet – 11 November 2013
DOI: 10.1016/S0140-6736(13)61950-9