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

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  • Additional Information
    • Source:
      Publisher: Nature Publishing Group on behalf of Cancer Research UK Country of Publication: England NLM ID: 0370635 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-1827 (Electronic) Linking ISSN: 00070920 NLM ISO Abbreviation: Br J Cancer Subsets: MEDLINE
    • Publication Information:
      Publication: 2002- : London : Nature Publishing Group on behalf of Cancer Research UK
      Original Publication: London, Lewis.
    • Subject Terms:
      Breast Neoplasms/*radiotherapy ; Breast Neoplasms/*surgery ; Carcinoma, Ductal, Breast/*radiotherapy ; Carcinoma, Ductal, Breast/*surgery ; Mastectomy, Segmental/*methods; Aged ; Aged, 80 and over ; Breast Neoplasms/pathology ; Carcinoma, Ductal, Breast/pathology ; Combined Modality Therapy ; Female ; Humans ; Intraoperative Care ; Middle Aged ; Prognosis ; Survival Analysis ; Treatment Outcome ; Tumor Burden ; Whole-Body Irradiation
    • 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).
      (© 2021. The Author(s).)
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    • Grant Information:
      14/49/13 United Kingdom DH_ Department of Health; 07/60/49 United Kingdom DH_ Department of Health; 10/104/07 United Kingdom DH_ Department of Health
    • Molecular Sequence:
      ClinicalTrials.gov NCT00983684
    • Publication Date:
      Date Created: 20210526 Date Completed: 20211210 Latest Revision: 20231107
    • Publication Date:
      20231107
    • Accession Number:
      PMC8329051
    • Accession Number:
      10.1038/s41416-021-01440-8
    • Accession Number:
      34035435