Single dose radiotherapy could transform breast cancer care 

11/11/2013 00:00 
A ‘single shot’ of radiation could revolutionise breast cancer treatment in the NHS according to the findings of a 13-year study.

The results from one of the biggest international breast cancer trials ever run, show that a single dose of radiotherapy during surgery is just as effective as the traditional 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 (TARGIT) 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.

Radiotherapy is usually given after surgery to remove a cancer, to reduce the risk of it returning; but the standard method involves women coming back to hospital after their operation, often on a daily basis for several weeks.

The new approach means selected patients receive just one dose of radiation during surgery to remove breast cancer. Rather than targeting the whole breast, a probe is inserted into the breast so that it can target the exact site of the cancer.

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 Jayant Vaidya, who works at the University College, Royal Free and Whittington hospitals. UCLH Charity provided a £100,000 equipment grant for the project.

The results are published today in The Lancet. The trial followed almost 3,500 women aged 45 and over who had early breast cancer, comparing outcomes for those who received TARGIT with women who had standard radiotherapy. Of these, over 1,200 were followed for an average five years.

Researchers found that for both groups, the risks of breast cancer recurring or of death from the disease were similar. However, women in the TARGIT group were also far less likely to suffer unpleasant side effects associated with radiotherapy. Somewhat unexpectedly, deaths from causes other than breast cancer were lower in the TARGIT group – 1.3 per cent compared with 4.4 per cent.

TARGIT also overcomes another disadvantage of standard radiotherapy, where the wound from the incision must first be allowed to heal, leaving time for cancer cells to repopulate. If chemotherapy is used, as is often necessary in more aggressive cancers, radiation may be delayed by six months.

According to Professor Vaidya: “The most important benefit of TARGIT for a woman with breast cancer is that it allows her to complete her entire local treatment at the time of her operation, with lower toxicity to the breast, the heart and other organs   Our research supports the use of TARGIT concurrent with lumpectomy, provided patients are selected carefully, and should allow patients and their clinicians to make a more informed choice about individualising their treatment, saving time, money, breasts, and lives.”

The study authors argue that using TARGIT could mean that more women would be able to conserve their breasts. At present, many women who are eligible for a lumpectomy may end up having a full mastectomy (after which no radiotherapy is required), simply because they cannot deal with repeatedly returning to hospital for the therapy.

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.”

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