Long-Term Results of the TARGIT-A Trial: More Questions than Answers.
Breast cancer
INTRABEAM technique
Intraoperative radiotherapy (IORT)
Partial breast irradiation
Journal
Breast care (Basel, Switzerland)
ISSN: 1661-3791
Titre abrégé: Breast Care (Basel)
Pays: Switzerland
ID NLM: 101254060
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
04
02
2021
accepted:
20
02
2021
entrez:
31
3
2022
pubmed:
1
4
2022
medline:
1
4
2022
Statut:
ppublish
Résumé
During the last decade, partial breast irradiation (PBI) has gained traction as a relevant treatment option for patients with early-stage low-risk breast cancer after breast-conserving surgery. The TARGIT-A prospective randomized trial compared a "risk-adapted" intraoperative radiotherapy (IORT) approach with 50-kv X-rays (INTRABEAM®) as the PBI followed by optional whole-breast irradiation (WBI) and conventional adjuvant WBI in terms of observed 5-year in-breast recurrence rates. Recently, long-term data were published. Since the first publication of the TARGIT-A trial, a broad debate has been emerged regarding several uncertainties and limitations associated with data analysis and interpretation. Our main objective was to summarize the data, with an emphasis on the updated report and the resulting implications. From our point of view, the previously unresolved questions still remain and more have been added, especially with regard to the study design, a change in the primary outcome measure, the significant number of patients lost to follow-up, and the lack of a subgroup analysis according to risk factors and treatment specifications. Taking into account the abovementioned limitations of the recently published long-term results of the TARGIT-A trial, the German Society of Radiation Oncology (DEGRO) Breast Cancer Expert Panel adheres to its recently published recommendations on PBI: "the 50-kV system (INTRABEAM) cannot be recommended for routine adjuvant PBI treatment after breast-conserving surgery."
Sections du résumé
Background
UNASSIGNED
During the last decade, partial breast irradiation (PBI) has gained traction as a relevant treatment option for patients with early-stage low-risk breast cancer after breast-conserving surgery. The TARGIT-A prospective randomized trial compared a "risk-adapted" intraoperative radiotherapy (IORT) approach with 50-kv X-rays (INTRABEAM®) as the PBI followed by optional whole-breast irradiation (WBI) and conventional adjuvant WBI in terms of observed 5-year in-breast recurrence rates. Recently, long-term data were published. Since the first publication of the TARGIT-A trial, a broad debate has been emerged regarding several uncertainties and limitations associated with data analysis and interpretation. Our main objective was to summarize the data, with an emphasis on the updated report and the resulting implications.
Summary
UNASSIGNED
From our point of view, the previously unresolved questions still remain and more have been added, especially with regard to the study design, a change in the primary outcome measure, the significant number of patients lost to follow-up, and the lack of a subgroup analysis according to risk factors and treatment specifications.
Key Message
UNASSIGNED
Taking into account the abovementioned limitations of the recently published long-term results of the TARGIT-A trial, the German Society of Radiation Oncology (DEGRO) Breast Cancer Expert Panel adheres to its recently published recommendations on PBI: "the 50-kV system (INTRABEAM) cannot be recommended for routine adjuvant PBI treatment after breast-conserving surgery."
Identifiants
pubmed: 35355706
doi: 10.1159/000515386
pii: brc-0017-0081
pmc: PMC8914270
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
81-84Informations de copyright
Copyright © 2021 by S. Karger AG, Basel.
Déclaration de conflit d'intérêts
V.S. declares consultation fees from Nucletron Operations BV, an Elekta Company, outside the submitted work. D.K. has received honoraria from Merck Sharp & Dome, outside of the submitted work. F.S. has received a study grant from Intraop Medical. G.F. has received a honorarium from Roche, outside of the submitted work. M.P., R.B., S.C., M.-N.D., J.D., P.F., R.F., Wu.H., Wo.H., T.H., R.S., and W.B. have no conflicts of interest to declare.
Références
Lancet. 2016 Jan 16;387(10015):229-38
pubmed: 26494415
Lancet. 2014 May 17;383(9930):1718-9
pubmed: 24835612
Strahlenther Onkol. 2020 Apr;196(4):349-355
pubmed: 31641788
Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):960-961
pubmed: 26194670
JAMA Oncol. 2020 Jul 1;6(7):e200249
pubmed: 32239210
JAMA Oncol. 2020 Oct 1;6(10):1636
pubmed: 32789502
Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):959-960
pubmed: 26194669
Lancet. 2017 Sep 9;390(10099):1048-1060
pubmed: 28779963
Strahlenther Onkol. 2019 Jul;195(7):640-647
pubmed: 30796496
BMJ. 2020 Aug 19;370:m2836
pubmed: 32816842
Lancet. 2014 May 17;383(9930):1717
pubmed: 24835610
Lancet. 2014 May 17;383(9930):1716-7
pubmed: 24835609
Lancet Oncol. 2015 Mar;16(3):266-73
pubmed: 25637340
Eur J Surg Oncol. 2002 Jun;28(4):447-54
pubmed: 12099658
Lancet. 2014 May 17;383(9930):1716
pubmed: 24835608
Int J Radiat Oncol Biol Phys. 2020 Jul 15;107(4):701-709
pubmed: 32302682
Strahlenther Onkol. 2020 Sep;196(9):749-763
pubmed: 32350554
Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):957-958
pubmed: 26194666
JAMA Oncol. 2020 Oct 1;6(10):1636-1637
pubmed: 32789481
Int J Radiat Oncol Biol Phys. 2015 Jul 1;92(3):491-7
pubmed: 26068479
Lancet. 2014 May 17;383(9930):1717-8
pubmed: 24835611
Ann Surg Oncol. 2014 Nov;21(12):3793-9
pubmed: 25138079
Lancet. 2014 Feb 15;383(9917):603-13
pubmed: 24224997
Rep Pract Oncol Radiother. 2020 Sep-Oct;25(5):780-782
pubmed: 32904220
Ann Oncol. 2001 Aug;12(8):1075-80
pubmed: 11583188