TARGIT: TARGETED INTRA-OPERATIVE RADIATION THERAPY
Breast cancer is a relatively common disease, and is (fortunately) amenable to treatment by surgery, followed by radiotherapy and/or chemotherapy and/or hormonal therapy. Increased awareness and early detection have led to more women presenting with small, early stage tumours that can be removed by local excision (rather than mastectomy). However, local recurrence should be avoided, and this can be managed by the application of radiotherapy to the remaining breast tissue. Most women who receive such radiotherapy have to attend hospital for a few minutes a day over a period of several weeks. Treatments are now available to give the radiotherapy once, in the operating room shortly after the surgeon has removed the tumour.
TARGIT is an international randomised clinical trial designed to test the hypothesis that
the strategy of delivering a single dose of targeted intraoperative radiotherapy (IORT)
in patients eligible for breast conserving therapy (with the addition of whole breast
radiotherapy in those patients at high risk of recurrence elsewhere in the breast [eg lobular
carcinomas and extensive intraduct component]) is equivalent to a conventional course of
post-operative external beam radiotherapy (EBRT). The primary endpoints are local and
loco-regional recurrence rates.
Message from the TARGIT International Steering Committee chairmen
Prof Mike Baum
Professor Emeritus of Surgery, University College London, UK
Over the last 7 years since I first started work on IORT with the INTRABEAM technique, I’ve noted a change of attitude from one of scepticism if not hostility to one of enthusiasm. In fact, since some centres now want to use the treatment routinely on patients, I now have to urge caution and ask people to wait for the results of TARGIT or at least join the trial before treating patients off protocol. In the last 12 months I’ve been asked to talk on the subject in Australia, Mexico, California, New York, Italy and Denmark. In January I went to Bangkok to visit the director of the new Thailand breast cancer centre who thinks this technique will be ideal for the emerging nations of South East Asia.
I thank those of you who are supporting the trial and ask that you encourage other centres to join so that we might get an answer to this important question as rapidly as possible - our patients want it!!
Prof David Joseph
Clinical Professor, Department of Radiation Oncology, Sir Charles Gairdner Hospital, Western Australia
Intra-operative radiotherapy and partial breast irradiation have come a long way since the introduction of the INTRABEAM device (for the management of early breast cancer) in the UK in 1997. What was a controversial treatment option has now progressed into the mainstream, and the question of partial breast irradiation considered a priority in the treatment of early breast cancer.
There are now various randomised and non-randomised trials around the world which are investigating the use of partial breast irradiation in various forms, however the TARGIT trial, utilising the Intrabeam device, is still the only trial that utilises a single surgical procedure to deliver radiotherapy that can be performed in a standard operating theatre. TARGIT offers the easiest form of IORT for treatment centres and for patients, and because of this, it could be performed within any hospital or treatment centre.