• Jayant S Vaidya, Michael Baum, Jeffrey S Tobias, Samuele Massarut, Frederik Wenz, Olive Murphy, Basil Hilaris, Joan Houghton, Christobel Saunders, Tammy Corica, Mario Roncadin, Uta Kraus-Tiefenbacher, Frank Melchaert, Mohammed Keshtgar, Richard Sainsbury, Michael Douek, Elly Harrison, Alastair Thompson, and David Joseph.
• Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK. j.s.vaidya@dundee.ac.uk
• Int. J. Radiat. Oncol. Biol. Phys. 2006 Dec 1; 66 (5): 1335-8.

PurposePatients undergoing breast-conserving surgery were offered boost radiotherapy with targeted intraoperative radiotherapy (TARGIT) using the Intrabeam system to test the feasibility, safety, and efficacy of the new approach.Methods And MaterialsWe treated 302 cancers in 301 unselected patients. This was not a low-risk group. One-third of patients (98/301) were younger than 51 years of age. More than half of the tumors (172, 57%) were between 1 cm and 2 cm, and one-fifth (62, 21%) were >2 cm; 29% (86) had a Grade 3 tumor and, in 29% (87), axillary lymph nodes contained metastasis. After primary surgery, 20 Gy was delivered intraoperatively to the surface of the tumor bed, followed by external-beam radiotherapy (EBRT), but excluding the usual boost.ResultsThe treatment was well tolerated. The follow-up ranged from 3 to 80 months (164 and 90 patients completed 2 and 3 years follow-up, respectively). Four patients (1.3%) had local recurrence. The Kaplan-Meier estimate of local recurrence is 2.6% (SE = 1.7) at 5 years. This compares favorably with the 4.3% recurrence rate in boosted patients from the EORTC boost study, in which only 8.1% patients were node-positive, as opposed to 29% in our series.ConclusionTargeted intraoperative radiotherapy combined with EBRT results in a low local recurrence rate. This could be attributed to both accurate targeting and timeliness of the treatment. These data support the need for a randomized trial to test whether the TARGIT boost is superior to conventional external boost, especially in high-risk women.

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