Saturday, 25 June 2016

TARGIT (targeted intraoperative radiotherapy)

It is a technique of giving radiotherapy to the tissues surrounding a cancer after its surgical removal. In patients having lumpectomy for breast cancer, the TARGIT-A(lone) randomized controlled trial [1] tested whether TARGIT within a risk-adapted approach was non-inferior to conventional course of external beam postoperative radiotherapy given over several weeks. The conclusion was TARGIT concurrent with lumpectomy should be considered an option for eligible patients [2]. The ongoing TARGIT-B(oost) randomized controlled trial is testing whether TARGIT tumour bed boost given after lumpectomy for breast cancer in younger patients or those with a high risk of recurrence is superior to conventional external beam radiotherapy boost for breast cancer [3].
The TARGIT technique is performed by low energy X-rays (50kV maximum) at the tip of a tube. The radiation source is inserted into the tumour bed immediately after excision of the tumour and switched on for 20-35 minutes to provide intra-operative radiotherapy accurately targeted to the tissues that are at highest risk of local recurrence [4].
Other nomenclatures: TARGIT-BQR (boost quality registry) [5], TARGIT-C (consolidation) [5], TARGIT-D (ductal carcinoma in situ) [6], TARGIT-E (elderly) [7], TARGIT-R (retrospective) [8], TARGIT-US (United States) [9].
Bibliographic references:
[1] Vaidya JSWenz FBulsara MTobias JSJoseph DJKeshtgar M, et al;  TARGIT trialists' groupRisk-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 Feb 15;383(9917):603-13. Available at: http://dx.doi.org/10.1016/S0140-6736(13)61950-9.
[2] En.wikibooks.org. (2016). Radiation Oncology/Breast/Partial breast irradiation - Wikibooks, open books for an open world. [online] Available at: https://en.wikibooks.org/wiki/Radiation_Oncology/Breast/Partial_breast_irradiation [Accessed 25 Jun. 2016].
[3] Wikipedia. (2016). Targeted intra-operative radiotherapy. [online] Available at: https://en.m.wikipedia.org/wiki/Targeted_intra-operative_radiotherapy [Accessed 25 Jun. 2016].
[4] Ucl.ac.uk. (2016). TARGIT-B. [online] Available at: http://www.ucl.ac.uk/silva/surgical-interventional-trials-unit/trials/breast/targit-trials/targit-b [Accessed 25 Jun. 2016].
[5] Sperk EAstor D, Keller AWelzel GGerhardt ATuschy Bet alA cohort analysis to identify eligible patients for intraoperative radiotherapy (IORT) of early breast cancer. Radiat Oncol. 2014; 9: 154. Available at: http://dx.doi.org/10.1186%2F1748-717X-9-154.
[6] Williams, N. and Reynolds, C. (2014). Treating Patients with TARGIT. In: M. Keshtgar, K. Pigott and F. Wenz, ed., Targeted Intraoperative Radiotherapy in Oncology, 1st ed. Springer-Verlag Berlin Heidelberg, pp.141-145.
[7] Neumaier CElena SGrit WYasser AMUta KTAnke K, et alTARGIT-E(lderly)--prospective phase II study of intraoperative radiotherapy (IORT) in elderly patients with small breast cancer. BMC Cancer. 2012 May 8;12:171. Available at: http://dx.doi.org/10.1186/1471-2407-12-171.
[8] Valente SATendulkar RDCherian SO'Rourke CGreif JMBailey L, et alTARGIT-R (Retrospective): North American Experience with Intraoperative Radiation Using Low-Kilovoltage X-Rays for Breast Cancer. Ann Surg Oncol. 2016 May 9. Available at: http://dx.doi.org/10.1245/s10434-016-5240-1.
[9] Clinicaltrials.gov. (2016). Targeted Intraoperative Radiotherapy United States (TARGIT-US) Registry Trial - Full Text View - ClinicalTrials.gov. [online] Available at: https://clinicaltrials.gov/ct2/show/NCT01570998 [Accessed 25 Jun. 2016].