Meet the trial team: (from l to r) Mary Falzon, consultant pathologist; patient Josephine Ford; Jayant Vaidya, consultant surgeon; Professor Jeffrey Tobias, consultant oncologist and Dr Chris Stacey, principal physicist
The trial, carried out by academics and consultants at UCLH and UCL, and at international centres across nine countries, has treated more than 2,000 women with targeted intraoperative radiotherapy (TARGIT).
The new approach means selected patients receive just one dose of radiation during surgery to remove breast cancer. A probe is inserted into the breast so that it can target the exact site of the cancer.
Results published in the Lancet show that in selected patients, the new method appears to be just as effective as conventional post-operative breast cancer treatment which can be a lengthy process. A prolonged course of radiotherapy can mean 20 or 30 visits to hospital over five to six weeks.
However targeted intraoperative radiotherapy benefits patients by reducing their exposure to radiation toxicity and reducing the number of journeys they have to make to hospital. According to the authors, for the NHS it could mean reduced waiting lists for breast cancer treatment and estimated savings of as much as £15 million a year, despite the initial outlay for new equipment.
The trial was designed and led by UCLH oncologist, Professor Jeffrey Tobias, former UCLH consultant surgeon (now Professor Emeritus) Professor Mike Baum, of UCL, and breast surgeon and UCLH oncologist Jayant Vaidya, who works at the University College, Royal Free and Whittington hospitals.
Professor Tobias, who enrolled the first ever patient on the trial at the former Middlesex Hospital in London along with Mr Vaidya, said: "I think the reason why it works so well is because of the precision of the treatment. It eradicates the very highest risk area - the part of the breast from which the tumour was removed. It is given in a single dose via an intraoperative probe and the conventional surgery is extended by just 30-40 minutes while the patient is asleep under anaesthetic.
“It also means there is an otherwise unachievable degree of immediacy because the cancer is taken out and radiation goes in as soon as the surgery is complete - rather than weeks after. The surgery and radiotherapy which would otherwise take around five weeks is done and dusted.”
The results of the trial were presented at the American Society of Clinical Oncology (ASCO) conference in Chicago on June 7 by Professor Baum.
Mr Vaidya said: “This has been my dream for the last 15 years. The new treatment could mean that many more women could conserve their breasts. TARGIT saves time, money and breasts.
“Scientifically, the results change the way of thinking about breast cancer and its treatment. It suggests that in selected patients the whole breast does not need to be treated and that the radiation dose and that the radiation dose can be much lower.”
Josephine Ford, 80, was diagnosed with breast cancer in February 2008 and was successfully treated with TARGIT in May 2008. She said the diagnosis ‘knocked me bandy’ but when she heard about the treatment it gave her renewed optimism.
“It simplified everything and made the process less traumatic. I felt that once the operation was done that was it and I would be up and running. It made life so much easier and meant that I didn’t have to come back to the radiotherapy department on a daily basis for five or six weeks.”
Patients from 28 international centres, coordinated from the Trials Office in the Department of Surgery at UCL with support from Cancer Research UK, were treated using the same procedure and compared to others using the conventional method. Recurrence rates using the new form of treatment were no higher.
Professor Tobias added: "It means that we have now come up with a model of treatment which appears to be equally effective as the standard treatment, with lower toxicity and very much less trouble, discomfort and inconvenience for patients. Breast cancer is the commonest type of malignancy of women in the Western world. The implications of this new form of treatment are potentially enormous. "