Early breast cancer is enough to target radiotherapy once?

Globally, about 2 million women are diagnosed with breast cancer each year.
for most early-stage patients, there is often an opportunity for breast-preservation surgery, but at the same time complementary radiotherapy is required to reduce the risk of recurrence.
, full-breast radiotherapy, which lasts for several weeks after surgery, is standard.
to reduce the burden of radiation therapy for breast cancer patients, the industry has been exploring and optimizing radiotherapy strategies for many years.
Recently, the long-term results of the TARGIT-A trial, published in the British Medical Journal (BMJ), showed that for early breast cancer patients, single-dose targeted radiotherapy during excision had a similar effect to postoperative full-breast radiotherapy, and reduced non-breast cancer mortality.
Screenshot Source: 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-surgery targeted radiotherapy.
, they promoted international cooperation and conducted the TARGIT-A trial.
this is an open-label, cross-border study conducted at 32 clinical centres around the world that includes women over 45 years of age with early-stage immersive breast catheter cancer who are eligible for breast-preservation surgery.
between 2000 and 2012, subjects were randomly grouped 1:1 to receive in-operative targeted radiotherapy based on risk adjustment, or to receive full-breast radiotherapy on a daily basis 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 rates, mainly due to lower risk of death from non-breast causes such as cardiovascular causes and other cancers.
, despite achieving non-poor effectiveness, 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.
breast cancer experts say this means clinicians need to weigh the potential benefits and risks of in-seismotherapy to 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 (16) 7 events vs 147 events; HR 1.13, P-0.28), no mastectomy survival rate (170 events vs 175 events; HR 0.96, P-plus 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) 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 deaths 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 said the long-term results showed that "a single dose of risk-adjusted (risk-adjusted) target radiotherapy 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 in recent years many more trials aimed at simplifying radiotherapy have yielded notable results.
2015, accelerated partial mammary exposure (APBI) released key 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, Dr. Rachel Jimenez, professor of oncology radiology at Harvard Medical School and Massachusetts General Hospital (MGH), commented, "It's not clear whether the long-term results of the TARGIT trial will change clinical practice."
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.
", 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.
references: s1. Vaidya Jayant S, et al., (2020). Long term survival and local control outcomes from 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 Can women with early breast cancer skip post-op radiation? . Retrieved August 27, 2020, Jay Fromant 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, targeted radiotherapy once in surgery is enough?