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Intraoperative Radiation Therapy During Lumpectomy Seems as Good as Traditional Whole-Breast Radiation Therapy for Early-Stage Breast Cancer

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A single dose of radiation therapy given during lumpectomy surgery — called intraoperative radiation therapy — offered about the same outcomes for early-stage breast cancer as traditional whole-breast radiation therapy given after surgery, according to a study.

The research was published on Aug. 19, 2020, by the journal BMJ. Read “Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial.”

Whole-breast radiation therapy after lumpectomy

Traditional whole-breast radiation therapy is recommended to most people who have lumpectomy to remove breast cancer. Radiation after lumpectomy aims to destroy any cancer cells that may have been left in the breast after the tumor was removed.

As its name suggests, whole-breast radiation therapy aims a beam of radiation at the entire breast affected by cancer.

Many studies have shown the short- and long-term effectiveness of traditional radiation therapy. The drawbacks of traditional radiation therapy include daily trips to the hospital or cancer center to get treated — often 5 days a week for 3 to 6 weeks. Maintaining this schedule can be difficult for some women. Traditional radiation therapy also may expose healthy tissue, such as the heart and lungs, to more radiation.

About intraoperative radiation therapy

Intraoperative radiation therapy, sometimes called IORT, is radiation therapy given during lumpectomy surgery, right after the cancer has been removed. While the underlying breast tissue is still exposed, a single, high dose of radiation is given directly to the area where the cancer was.

Besides being more convenient than a traditional radiation therapy schedule, the researchers who developed intraoperative radiation think it can better avoid exposing healthy tissue to radiation.

Still, studies looking at whether intraoperative radiation therapy is as good as whole-breast radiation given after surgery have offered mixed results.

The researchers did this study to offer more information with longer follow-up time.

About the study

The study, called the TARGIT-A study, included 2,298 women age 45 and older who had been diagnosed with early-stage breast cancer between 2000 and 2012 and were scheduled to have lumpectomy. The women lived in 10 countries, including the United Kingdom, Australia, the United States, Canada, and countries in Europe.

The women were randomly assigned to one of two radiation schedules:

  • 1,140 were assigned to have intraoperative radiation therapy during lumpectomy surgery
  • 1,158 women were assigned to have whole-breast radiation after lumpectomy surgery

Half the women were followed for fewer than 8.6 years and half were followed for a longer time. The longest time anyone in the study was followed was about 19 years.

The results showed no real difference between the two radiation schedules in:

  • local recurrence-free survival (how long the women lived without the cancer coming back in the same breast)
  • distant disease-free survival (how long the women lived without the cancer coming back in a part of the body away from the breast, such as the bones or liver)
  • overall survival (how long the women lived, whether or not the breast cancer came back)
  • breast cancer mortality (how many women died from breast cancer)

“The long-term results of this trial have shown that risk-adapted single-dose TARGIT-IORT [targeted intraoperative radiotherapy], given during lumpectomy, can effectively replace the mandatory use of several weeks of daily postoperative whole-breast radiotherapy in patients with breast cancer undergoing breast conservation,” the researchers wrote.

What this means for you

The results of this study are encouraging. And although this is a large study, more research needs to be done before doctors are sure that intraoperative radiation therapy is just as effective as traditional whole-breast radiation and are very clear on the types of breast cancer it can be used to treat.

It’s also important to know that intraoperative radiation therapy requires special equipment and is not widely available.

If you have been diagnosed with early-stage breast cancer, will be having lumpectomy, and are interested in intraoperative radiation therapy, you may want to talk to your doctor and ask if this type of radiation therapy is available in your area.

If intraoperative radiation therapy isn’t available, there are other types of internal radiation that can be used after lumpectomy. Sometimes called partial-breast radiation or brachytherapy, these internal radiation therapy methods typically use small pieces of radioactive material, called seeds, which are placed in the area around where the cancer was. The seeds emit radiation into the surrounding tissue. The area that's very close to the site of the original cancer is the area that is at highest risk of recurrence. These brachytherapy schedules are usually completed in 5 days.

For more information, visit the Breastcancer.org Types of Radiation page.

Written by: Jamie DePolo, senior editor

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