Early breast cancer is enough to target radiotherapy once?

In order to reduce the burden of radiation therapy for breast cancer patients, the industry has been exploring and optimizing radiotherapy strategies for many years.
The long-term results of the TARGIT-A trial, published in the British Medical Journal (BMJ), show that for early-stage breast cancer patients, single-dose targeted radiotherapy during excision has a similar effect to postoperative full-breast radiotherapy, and reduces non-breast cancer mortality.
: The BMJ study, launched 20 years ago, presents a "challenge to traditional dogms."
Jayant Vaidya, lead author of the study and professor of surgery and oncology at University College London, said the conventional view was that radiotherapy had to be performed multiple times and that full-breast radiotherapy was always essential.
" however, during whole-milk radiotherapy, scattering radiation can have side effects and longer radiotherapy cycles are not convenient enough.
the team's philosophy is that immediately focusing on the area around the tumor after removal is sufficient, and that if mortality is also improved, it will be more convenient and less costly for patients.
1998, the team treated the first patient with in-operative targeted radiotherapy.
, they promoted international cooperation and conducted the TARGIT-A trial.
is an open-label, cross-border study conducted at 32 clinical centers around the world that includes women over the age of 45 with early-stage immersive breast catheter cancer who are eligible for breast-preservation surgery.
between 2000 and 2012, subjects received in-operative targeted radiotherapy in a random group of 1:1, or full-breast radiotherapy for 3-6 consecutive weeks under standard procedures.
early results were debated in 2013, the team officially published the early results of the TARGIT-A trial in 3,451 patients in The Lancet.
data showed that breast cancer mortality was similar in patients with both radiotherapy strategies, but patients receiving targeted radiotherapy showed a trend towards lower overall mortality, mainly due to lower risk of death from non-breast causes such as cardiovascular causes and other cancers.
, despite non-poor performance, the 5-year local recurrence rate at the breast-protecting site was slightly higher (3.3% vs. 1.3%) in patients receiving targeted radiotherapy during surgery.
this risk that has sparked industry discussion.
some breast cancer experts say this means clinicians need to weigh the potential benefits and risks of in-surgery targeted radiotherapy for patients.
latest long-term results This analysis covered 2,298 subjects, with a medium follow-up time of 8.6 years and some patients receiving follow-up for nearly 19 years.
the trend of early results with the latest data.
5-year local recurrence rate was slightly higher in patients in the targeted radiotherapy group (2.11% vs 0.95%), but in the long term, there was no significant difference in the local recurrence rate between the two groups (167) Event vs 147 events; HR 1.13, P-0.28), no mastectomy survival rate (170 events vs 175 events; HR 0.96, P-28) 0.74), remote disease-free survival rate (133 events vs 148 events; HR 0.88, P=0.30), overall survival rate (110 deaths vs 131 deaths) There was no significant difference between HR 0.82, P=0.13) and breast cancer mortality (65 deaths vs 57 deaths; HR 1.12, P=0.54).
notable for significantly reducing the risk of non-breast cancer death in patients in the inoperative targeted radiotherapy group by 41% (45 deaths vs. 74 deaths; HR 0.59, P=0.005).
Based on these results, TARGIT-A researchers say the long-term results show that "single-dose targeted radiotherapy with risk-adjusted (risk-adjusted) in mastectomy can effectively replace breast cancer with full-breast radiotherapy up to several weeks after surgery."
more precise and simplified breast cancer radiotherapy strategies are also applied to early-stage breast cancer patients, and more trials aimed at simplifying radiotherapy have yielded notable results in recent years.
2015, accelerated partial mammary irradiation (APBI) released important results at the annual meeting of the American Society of Radiation Oncology (ASTRO).
radiotherapy with multiple catheters, the APBI results showed that the effect was comparable to that of full-breast radiotherapy, but with fewer side effects.
addition, the UK Fast and Fast-Forward trials assessed a one-week accelerated radiotherapy programme, demonstrating the feasibility of reducing the radiotherapy cycle.
Responsion to the discussion of in-surgery targeted radiotherapy," commented Dr. Rachel Jimenez, professor of oncology radiology at Harvard Medical School and Massachusetts General Hospital (MGH).
the early results of industry trial reports have been controversial over the past few years.
but as a clinician caring for breast cancer patients, it's good to see that the trend in early-stage breast cancer clinical trials is to explore increasingly targeted and simplified radiotherapy strategies.
" At this time, the trial's extended follow-up (TARGIT-Ex) is still in the process.
, as Dr. Jimenez says, expects more evidence to further reduce the burden of treatment for early-stage breast cancer patients.
reference: s1. Vaidya Jayant S, et al., (2020). Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy when lumpectomy (TARGIT-IORT) for early breast: TARGIT-A randomized clinical trial. BMJ, DOI: One-Off Blast of RT, Not Than Weeks, for Early Breast Cancer. Retrieved August 27, 2020, from .3 can women with early breast cancer skip post-op radiation? . Retrieved August 27, 2020, from s4' Jayant S Vaidya, ,et al., (2020). Risk-adapted targeted intraoperative radiotherapy versus whole-breasttherapy for breast cancer: 5-year results for local control and overall survival from TARGIT-A randomised trial. Lancet, DOI: Original Title: BMJ: Simplicity! Early breast cancer, is it enough to target radiotherapy once in surgery?