Information about Intrabeam TARGIT IORT

What is traditional radiotherapy?

 

Breast cancer is frequently treated by removing the cancerous lump with a margin of surrounding normal tissue. Radiotherapy to the remaining breast after such a lumpectomy reduces the risk of cancer coming back in the breast. Traditional external beam radiotherapy (EBRT) is given to the whole breast a few weeks after surgical removal of the cancer. As it is not focused, it needs to be given in daily small doses over three to six weeks. 

What is Intrabeam | TARGIT  | IORT?

TARGIT IORT stands for TARGeted Intraoperative radioTherapy. It is given during a lumpectomy for breast cancer, under the same anaesthetic, and it can replace traditional radiotherapy in suitable patients.

The TARGIT technique and the Intrabeam device was developed by clinical academics at University College London in 1998 in collaboration with the manufacturers.

After a cancer has been removed from the breast, TARGIT IORT allows your doctor to deliver a dose of radiotherapy directly into your breast, focussed to the site where the tumour had been. A small ball-shaped radiation applicator of the Intrabeam device is precisely placed in the tumour bed – the cavity left behind when the tumour is removed. TARGIT IORT is given over about 25 minutes, the applicator then is removed and skin closed. Intrabeam TARGIT intraoperative radiotherapy effectively treats the tissues where cancer might have come back while avoiding radiation to the skin and other healthy tissues such as the heart and lungs

This method has been used worldwide (over 260 centres in 38 countries) to treat over 45,000 patients for the past 16 years.

 
 
 
How is TARGIT IORT given?

 

TARGIT IORT is given using the Intrabeam device. It is given during your surgery, while you remain asleep, under general anaesthetic. It adds about 30 minutes to the operation.

It allows your specialist to deliver a focused dose of radiotherapy into the space where the breast cancer had been. This means that the radiotherapy is accurately targeted within the breast. This method avoids the potential damage to the skin, heart and lungs from traditional radiotherapy.

You do not feel any effects from the radiotherapy and there are no additional scars on your breast.

The surgical technique of Intrabeam TARGIT IORT, simplified:

The surgeon removes the cancerous lump  from the breast. The cancer and some surrounding normal tissue - the margin - is removed, leaving a small space called the tumour bed.

A ball-shaped radiation small applicator is positioned precisely within the breast cavity, at the site of tumour, using meticulously placed sutures.

Intrabeam TARGIT IORT is given as focused dose of targeted intraoperative radiotherapy into the breast, avoiding damage to the skin, heart and lungs.This takes about 30 minutes

The breast wound and skin is surgically closed as usual.

Is Intrabeam TARGIT IORT Effective?

 

TARGIT IORT has been extensively tested in clinical trials over the past 15 years. The TARGIT-A trial, included patients treated in 32 hospitals in UK, Europe, USA and Australia.

 

In this trial 1140 patients were randomly allocated to receive risk-adapted single-dose TARGIT IORT during lumpectomy and 1158 patients to receive traditional post-operative radiotherapy given daily for 3 to 6 weeks. TARGIT IORT is given using the Intrabeam device.

 

At long-term follow up, (median 9 years, IQR 7 to 11 years), both treatments achieved the same level of breast cancer control, breast preservation and survival from breast cancer. Those allocated TARGIT-IORT had fewer deaths from cardiovascular / lung diseases and other cancers compared with those allocated EBRT (5 vs 10 out of every 100 women). In patients with grade 1 or grade 2 cancers this difference results in a statistically significant improvement in overall survival.

TARGIT IORT has only minimal side effects. There is less pain, better cosmetic outcome and higher quality of life compared with traditional radiotherapy.

Another benefit of TARGIT-IORT is that if there is local relapse (occurs in about 1 to 2% of cases), the long-term prognosis remains excellent - as good as those without a local recurrence. This is quite unlike the worse prognosis of patients who get a local recurrence after EBRT.

 

The UK National Institute of Care and Excellence (NICE) have determined that such difference is very small (1 to 2%) and have recommended it for suitable patients in the NHS hospitals that have the equipment and expertise.

 

What will it involve?

 

You will have your surgery the usual way and TARGIT IORT will be given using the Intrabeam device during the operation, under the same anaesthetic. Afterwards you will be able to go home on the same day or after an overnight stay. The wound care is similar to a standard operation, but the sutures or ‘Steristrips’ need to be left for 14 days.

Compared with traditional treatment, there is a lower risk of skin injury, but a slightly (1%) higher chance of fluid collecting in the wound. This does not delay the healing process.

Sometimes, in 15-20% of women, additional information from analysis of the cancer after surgery may mean that a smaller course of traditional EBRT required after TARGIT.

Who can and cannot have TARGIT IORT?

 

Women who are 45 or older with hormone receptor positive ductal type cancer suitable for breast conservation (tumour size up to 3.5cm) are eligible to receive TARGIT IORT instead of EBRT. Other women who have a higher risk cancer can receive TARGIT as a tumour-bed boost in addition to EBRT within the TARGIT-B trial. Women who need a mastectomy are not suitable.

Who needs to have additional whole breast radiotherapy after TARGIT-IORT?

A small proportion of patients (about 20%) who are found to have unexpected features post-operatively, after microscopic examination of the removed cancer, will be recommended additional whole breast radiotherapy. 

 

Click for the web - tool to help clinicians decide about additional radiotherapy after Intrabeam TARGIT IORT

Key Benefits of Intrabeam TARGIT IORT

 

Takes less time: TARGIT IORT is given during your surgery rather than after a few weeks' delay before a three or four week course of daily doses of traditional radiotherapy.

 

Precise radiotherapy: The radiotherapy is given into the breast exactly where the cancer had been, ensuring that it is accurately delivered.

 

Protects health tissues: There is reduced toxicity or damage to the skin, heart or lungs.

 

Avoids delay: Radiotherapy does not need to be delayed until after chemotherapy.

 

Flexible for your needs: Intrabeam TARGIT IORT can be supplemented with whole breast radiotherapy if it is thought necessary later on

Quality of life and cosmetic results: are as good or better than traditional radiotherapy

This pictogram is made by applying the 5-year results of the TARGIT-A trial to 100 women, to help patients and doctors to make a shared well-informed decision about TARGIT IORT
 
 
 
 
 
 
Decision aid Submitted to NICE and Red J
 

NICE approval

 

In February 2017 NICE issued a press release stating that they have recommended  the use of TARGIT IORT in the treatment women with early breast cancer. 

https://twitter.com/NICEcomms/status/831850566741471233

NICE issued their guidance on 31 January 2018 https://www.nice.org.uk/guidance/ta501

Click here for a printable information to help in a shared decision making that has been prepared  by TARGIT IORT specialists in collaboration with patients.