Chapter

Short Course Breast Radiotherapy

pp 327-346

Date:

A Risk-Adapted Approach to Breast Radiation Using Targeted Intraoperative Radiotherapy (TARGIT)

  • Jayant S. VaidyaAffiliated withProfessor of Surgery and Oncology, Clinical Trials Group, Division of Surgery and Interventional Science, University College London Email author 
  • , Jeffrey S. TobiasAffiliated withDepartment of Clinical Oncology, University College London Hospitals
  • , Frederik WenzAffiliated withDepartment of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg
  • , Samuele MassarutAffiliated withDepartment of Surgery, Centro di Riferimento Oncologico
  • , Max BulsaraAffiliated withDepartment of Biostatistics, University of Notre Dame
  • , Christobel SaundersAffiliated withSchool of Surgery, University of Western Australia
  • , Henrik FlygerAffiliated withDepartment of Breast Surgery, University of Copenhagen
  • , Michael AlvaradoAffiliated withDepartment of Surgery, University of California
  • , Wolfgang EiermannAffiliated withDepartment of Gynecology and Obstetrics, Red Cross Hospital
    • , Tammy CoricaAffiliated withDepartment of Radiation Oncology, Sir Charles Gairdner Hospital
    • , David JosephAffiliated withDepartment of Radiation Oncology, Sir Charles Gairdner Hospital
    • , Michael BaumAffiliated withClinical Trials Group, Division of Surgery and Interventional Science, University College London

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Abstract

Whole-organ detailed three-dimensional pathological analysis of mastectomy specimens vis-à-vis the results of breast-conserving surgery trials demonstrates a remarkable phenomenon: in addition to the main tumor, the mastectomy specimen reveals often multiple foci of cancer distributed widely in the breast volume. This is in contrast with the location of a local recurrence, which mostly occurs in the area around the original tumor – thus, it makes sense to focus radiation only around the original tumor. Based on this insight, the targeted intraoperative radiotherapy technique and the device to deliver it were developed in the late 1990s, the first case treated at the Middlesex Hospital, University College London, UK, on 2 July 1998. Pilot studies confirmed feasibility and safety, and in March 2000, the TARGIT-A randomized trial was launched.