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Is IORT ready for roll-out?

Emanuela Esposito1, Bauke Anninga2, Ian Honey3

  • 1Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK ; Department of Breast Surgery, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Naples 80131, Italy ; Department of Clinical Medicine and Surgery, Breast Unit, University of Naples Federico II, Naples 80131, Italy.

Ecancermedicalscience
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Summary

Intraoperative radiotherapy (IORT) for breast cancer did not change clinical practice despite meeting non-inferiority margins. Actual local recurrence rates were lower than predicted for both IORT and external beam radiation therapy (EBRT).

Keywords:
IORTbreast cancerintraoperative radiotherapy

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Area of Science:

  • Oncology
  • Radiotherapy
  • Surgical Oncology

Background:

  • Two large randomized controlled trials (TARGIT-A and ELIOT) evaluated intraoperative radiotherapy (IORT) in breast-conserving surgery.
  • Published 14 years after initiation, trial results have not altered current clinical practice regarding IORT use.

Purpose of the Study:

  • To assess the efficacy and safety of IORT compared to external beam radiation therapy (EBRT) in breast cancer patients undergoing breast-conserving surgery.
  • To evaluate local recurrence rates (LRR) and compare them against pre-specified non-inferiority margins.

Main Methods:

  • Analysis of data from the TARGIT-A and ELIOT randomized controlled trials.
  • Comparison of in-breast local recurrence rates (LRR) between IORT and EBRT arms.
  • Assessment of actual LRR against initially estimated rates for EBRT.

Main Results:

  • IORT met pre-specified non-inferiority margins for LRR (3.3% in TARGIT-A, 4.4% in ELIOT).
  • Actual LRR in EBRT arms were significantly lower than estimated (1.3% in TARGIT-A, 0.4% in ELIOT vs. estimated 6% and 3% respectively).
  • Median follow-up ranged from 2.4 to 5.8 years, with longer-term data emerging.

Conclusions:

  • IORT can be considered for select breast cancer patients, particularly those at low risk of local recurrence or suitable for partial breast irradiation, under strict protocols.
  • Further follow-up is needed to increase confidence in the data, but clinical implementation should not be unduly delayed.
  • Development of specific guidelines for IORT would aid clinicians in patient selection and treatment protocols.