New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

Jayant S. Vaidya; Max Bulsara; Michael Baum; Frederik Wenz; Samuele Massarut; Steffi Pigorsch; Michael Alvarado; Michael Douek; Christobel Saunders; Henrik Flyger; Wolfgang Eiermann; Chris Brew-Graves; Norman R. Williams; Ingrid Potyka; Nicholas Roberts; Marcelle Bernstein; Douglas Brown; Elena Sperk; Siobhan Laws; Marc Sütterlin; Tammy Corica; Steinar Lundgren; Dennis Holmes; Lorenzo Vinante; Fernando Bozza; Montserrat Pazos; Magali Le Blanc-Onfroy; Günther Gruber; Wojciech Polkowski; Konstantin J. Dedes; Marcus Niewald; Jens Blohmer; David McReady; Richard Hoefer; Pond Kelemen; Gloria Petralia; Mary Falzon; David Joseph; Jeffrey S. Tobias

doi:10.1038/s41416-021-01440-8

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

Jayant S. Vaidya (Lead / Corresponding author), Max Bulsara, Michael Baum, Frederik Wenz, Samuele Massarut, Steffi Pigorsch, Michael Alvarado, Michael Douek, Christobel Saunders, Henrik Flyger, Wolfgang Eiermann, Chris Brew-Graves, Norman R. Williams, Ingrid Potyka, Nicholas Roberts, Marcelle Bernstein, Douglas Brown, Elena Sperk, Siobhan Laws, Marc SütterlinTammy Corica, Steinar Lundgren, Dennis Holmes, Lorenzo Vinante, Fernando Bozza, Montserrat Pazos, Magali Le Blanc-Onfroy, Günther Gruber, Wojciech Polkowski, Konstantin J. Dedes, Marcus Niewald, Jens Blohmer, David McReady, Richard Hoefer, Pond Kelemen, Gloria Petralia, Mary Falzon, David Joseph, Jeffrey S. Tobias

Research output: Contribution to journal › Article › peer-review

29 Citations (Scopus)

71 Downloads (Pure)

Abstract

Background: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses.

Methods: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT.

Results: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091.

Conclusion: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect.

Trial Registration: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).

Original language	English
Pages (from-to)	380-389
Number of pages	10
Journal	British Journal of Cancer
Volume	125
Early online date	25 May 2021
DOIs	https://doi.org/10.1038/s41416-021-01440-8
Publication status	Published - 3 Aug 2021

Keywords

Breast cancer
Radiotherapy
Surgical oncology

ASJC Scopus subject areas

Oncology
Cancer Research

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1038/s41416-021-01440-8Licence: CC BY

Final Published VersionFinal published version, 599 KBLicence: CC BY

Cite this

Vaidya, J. S., Bulsara, M., Baum, M., Wenz, F., Massarut, S., Pigorsch, S., Alvarado, M., Douek, M., Saunders, C., Flyger, H., Eiermann, W., Brew-Graves, C., Williams, N. R., Potyka, I., Roberts, N., Bernstein, M., Brown, D., Sperk, E., Laws, S., ... Tobias, J. S. (2021). New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer. British Journal of Cancer, 125, 380-389. https://doi.org/10.1038/s41416-021-01440-8

@article{e056cb38445846dfa5d4dbb362521b02,

title = "New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer",

abstract = "Background: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses.Methods: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT.Results: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091.Conclusion: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect.Trial Registration: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).",

keywords = "Breast cancer, Radiotherapy, Surgical oncology",

author = "Vaidya, {Jayant S.} and Max Bulsara and Michael Baum and Frederik Wenz and Samuele Massarut and Steffi Pigorsch and Michael Alvarado and Michael Douek and Christobel Saunders and Henrik Flyger and Wolfgang Eiermann and Chris Brew-Graves and Williams, {Norman R.} and Ingrid Potyka and Nicholas Roberts and Marcelle Bernstein and Douglas Brown and Elena Sperk and Siobhan Laws and Marc S{\"u}tterlin and Tammy Corica and Steinar Lundgren and Dennis Holmes and Lorenzo Vinante and Fernando Bozza and Montserrat Pazos and Blanc-Onfroy, {Magali Le} and G{\"u}nther Gruber and Wojciech Polkowski and Dedes, {Konstantin J.} and Marcus Niewald and Jens Blohmer and David McReady and Richard Hoefer and Pond Kelemen and Gloria Petralia and Mary Falzon and David Joseph and Tobias, {Jeffrey S.}",

note = "Funding for this research was provided by: Health Technology Assessment Programme (HTA 10/04/07, HTA 14/49/13, HTA 07/60/49) Bundeszentrale f{\"u}r gesundheitliche Aufkl{\"a}rung (FKZ 01ZP0508) Bundesministerium f{\"u}r Bildung und Forschung (FKZ 01ZP0508) National Health and Medical Research Council",

year = "2021",

month = aug,

day = "3",

doi = "10.1038/s41416-021-01440-8",

language = "English",

volume = "125",

pages = "380--389",

journal = "British Journal of Cancer",

issn = "0007-0920",

publisher = "Springer Nature",

}

Vaidya, JS, Bulsara, M, Baum, M, Wenz, F, Massarut, S, Pigorsch, S, Alvarado, M, Douek, M, Saunders, C, Flyger, H, Eiermann, W, Brew-Graves, C, Williams, NR, Potyka, I, Roberts, N, Bernstein, M, Brown, D, Sperk, E, Laws, S, Sütterlin, M, Corica, T, Lundgren, S, Holmes, D, Vinante, L, Bozza, F, Pazos, M, Blanc-Onfroy, ML, Gruber, G, Polkowski, W, Dedes, KJ, Niewald, M, Blohmer, J, McReady, D, Hoefer, R, Kelemen, P, Petralia, G, Falzon, M, Joseph, D & Tobias, JS 2021, 'New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer', British Journal of Cancer, vol. 125, pp. 380-389. https://doi.org/10.1038/s41416-021-01440-8

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer. / Vaidya, Jayant S. (Lead / Corresponding author); Bulsara, Max; Baum, Michael et al.
In: British Journal of Cancer, Vol. 125, 03.08.2021, p. 380-389.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

AU - Vaidya, Jayant S.

AU - Bulsara, Max

AU - Baum, Michael

AU - Wenz, Frederik

AU - Massarut, Samuele

AU - Pigorsch, Steffi

AU - Alvarado, Michael

AU - Douek, Michael

AU - Saunders, Christobel

AU - Flyger, Henrik

AU - Eiermann, Wolfgang

AU - Brew-Graves, Chris

AU - Williams, Norman R.

AU - Potyka, Ingrid

AU - Roberts, Nicholas

AU - Bernstein, Marcelle

AU - Brown, Douglas

AU - Sperk, Elena

AU - Laws, Siobhan

AU - Sütterlin, Marc

AU - Corica, Tammy

AU - Lundgren, Steinar

AU - Holmes, Dennis

AU - Vinante, Lorenzo

AU - Bozza, Fernando

AU - Pazos, Montserrat

AU - Blanc-Onfroy, Magali Le

AU - Gruber, Günther

AU - Polkowski, Wojciech

AU - Dedes, Konstantin J.

AU - Niewald, Marcus

AU - Blohmer, Jens

AU - McReady, David

AU - Hoefer, Richard

AU - Kelemen, Pond

AU - Petralia, Gloria

AU - Falzon, Mary

AU - Joseph, David

AU - Tobias, Jeffrey S.

N1 - Funding for this research was provided by: Health Technology Assessment Programme (HTA 10/04/07, HTA 14/49/13, HTA 07/60/49) Bundeszentrale für gesundheitliche Aufklärung (FKZ 01ZP0508) Bundesministerium für Bildung und Forschung (FKZ 01ZP0508) National Health and Medical Research Council

PY - 2021/8/3

Y1 - 2021/8/3

N2 - Background: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses.Methods: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT.Results: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091.Conclusion: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect.Trial Registration: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).

AB - Background: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses.Methods: In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT.Results: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091.Conclusion: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect.Trial Registration: ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).

KW - Breast cancer

KW - Radiotherapy

KW - Surgical oncology

UR - http://www.scopus.com/inward/record.url?scp=85106457037&partnerID=8YFLogxK

U2 - 10.1038/s41416-021-01440-8

DO - 10.1038/s41416-021-01440-8

M3 - Article

C2 - 34035435

SN - 0007-0920

VL - 125

SP - 380

EP - 389

JO - British Journal of Cancer

JF - British Journal of Cancer

ER -

New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this