Intraoperative radiotherapy for early breast cancer - insufficient evidence to change practice
Peter D Sasieni, Elinor J Sawyer, Peter D Sasieni, Elinor J Sawyer
Abstract
We argue that the evidence remains insufficient for use of intraoperative radiotherapy (IORT) in women with early stage breast cancer outside of a clinical trial, as the recently reported TARGIT-A trial does not provide sufficient evidence to conclude that IORT is superior to no radiotherapy.
Conflict of interest statement
The authors declare no competing interests.
References
- Vaidya JS, et al. 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. BMJ. 2020;370:m2836. doi: 10.1136/bmj.m2836.
- Correa C, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract. Radiat. Oncol. 2017;7:73–79. doi: 10.1016/j.prro.2016.09.007.
- Early Breast Cancer Trialists’ Collaborative. et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–1716. doi: 10.1016/S0140-6736(11)61629-2.
- Vaidya JS, et al. An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial) Health Technol. Assess. 2016;20:1–188. doi: 10.3310/hta20730.
- Vaidya JS, et al. Effect of delayed targeted intraoperative radiotherapy vs whole-breast radiotherapy on local recurrence and survival: long-term results from the TARGIT-A randomized clinical trial in early breast cancer. JAMA Oncol. 2020;6:e200249. doi: 10.1001/jamaoncol.2020.0249.
- Kunkler IH, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16:266–273. doi: 10.1016/S1470-2045(14)71221-5.
- Veronesi U, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol. 2013;14:1269–1277. doi: 10.1016/S1470-2045(13)70497-2.
- Hughes KS, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J. Clin. Oncol. 2013;31:2382–2387. doi: 10.1200/JCO.2012.45.2615.
- Murray Brunt A, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395:1613–1626. doi: 10.1016/S0140-6736(20)30932-6.
- Fleming TR. Current issues in non-inferiority trials. Stat. Med. 2008;27:317–332. doi: 10.1002/sim.2855.
Source: PubMed