Intraoperative Accelerated Partial Breast Irradiation: Caution Still Warranted

Abstract

As new data emerge from prospective randomized trials examining novel local treatment strategies for early-stage breast cancer, clinicians are, more than ever, challenged with the selection of appropriate candidates for less versus more local therapy. This month's Oncology Scan from the Breast Cancer editorial team focuses on results from 2 important large, randomized trials assessing accelerated partial breast irradiation (APBI) using intraoperative radiation therapy (IORT) compared with standard external beam whole-breast irradiation (WBI) ( 1 Veronesi U. Orecchia R. Maisonneuve P. et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): A randomised controlled equivalence trial. Lancet Oncol. 2013; 14: 1269-1277 Abstract Full Text Full Text PDF PubMed Scopus (561) Google Scholar , 2 Vaidya J.S. Wenz F. Bulsara M. et al. TARGIT trialists' group. 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. Lancet. 2014; 383: 603-613 Abstract Full Text Full Text PDF PubMed Scopus (630) Google Scholar ). Intraoperative methods, which use a single dose of RT delivered at the time of breast-conserving surgery, were pioneered by the European Institute of Oncology (EIO) group in Milan, Italy ( 1 Veronesi U. Orecchia R. Maisonneuve P. et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): A randomised controlled equivalence trial. Lancet Oncol. 2013; 14: 1269-1277 Abstract Full Text Full Text PDF PubMed Scopus (561) Google Scholar ) and the Targeted Intraoperative Radiotherapy (TARGIT) Trialists group in the United Kingdom ( 2 Vaidya J.S. Wenz F. Bulsara M. et al. TARGIT trialists' group. 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. Lancet. 2014; 383: 603-613 Abstract Full Text Full Text PDF PubMed Scopus (630) Google Scholar ). This novel technique, which offers the potential advantages of short treatment time, improved patient convenience, and possible improved normal tissue sparing, has significantly fewer available data relative to brachytherapy-based APBI. Although the IORT strategies used in the Electron Intraoperative Radiotherapy (ELIOT) trial and the Intrabeam TARGIT-A trial are distinct from one another, both studies have received considerable media attention, with preliminary data suggesting promising early results ( 3 Veronesi U. Orecchia R. Luini A. et al. Intraoperative radiotherapy during breast conserving surgery: A study on 1,822 cases treated with electrons. Breast Cancer Res Treat. 2010; 124: 141-151 Crossref PubMed Scopus (195) Google Scholar , 4 Vaidya J.S. Joseph D.J. Tobias J.S. et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): An international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010; 376: 91-102 Abstract Full Text Full Text PDF PubMed Scopus (582) Google Scholar ). In Regard to Moran et al and Smith et alInternational Journal of Radiation Oncology, Biology, PhysicsVol. 90Issue 4PreviewTo the Editor: Two articles in a recent issue of International Journal of Radiation Oncology, Biology, Physics discuss issues pertaining to the use of radiation therapy in patients undergoing breast-conserving surgery. We find it contradictory that, on one hand, the editorial by Moran and Truong (1) counsels caution before intraoperative radiation therapy (IORT) can be considered in place of conventional external beam whole-breast radiation therapy for any patient, whereas the scientific study by Smith et al (2) investigates whether a group of patients can be identified for whom radiation therapy can be entirely omitted. Full-Text PDF