Target IORT: Intraoperative radiotherapy for breast cancer

In this informative article, Professor Jayant Vaidya, a leading consultant oncoplastic breast surgeon and professor of surgery, sheds light on targeted intraoperative radiotherapy, also known as target IORT, and its applications in the treatment of breast cancer. The highly respected specialist discusses how the treatment is applied and which types of breast cancer are suitable for this form of radiotherapy. Additionally, Professor Vaidya shares his expert insight on the benefits of target IORT as evidenced by international study data.

What makes target IORT stand out in cancer radiotherapy and how does it improve treatment effectiveness?

Targeted intraoperative radiotherapy, or target IORT, is unique in many ways. It was conceived based on the biological fact that when a cancer is treated by with a lumpectomy, it recurs in a small proportion of people and seems to come back around the site of the tumour. Even though there may be microscopic tumours in other parts of the breast, they don't seem to grow.

Therefore, at UCL, we devised a technique of giving radiation only around the tumour bed after the cancer is removed. This is target IORT, performed in collaboration with Carl Zeiss. The radiotherapy is given immediately after the cancer is removed. While the patient is still asleep under the same anaesthetic, a radiotherapy device is inserted into the tumour bed for about 20 to 25 minutes. Once it has been taken out, the breast is closed and sutured, meaning the whole treatment is finished in one go.

This is highly convenient for the patient, avoiding a postoperative course of radiotherapy which can take weeks of daily treatments, and ensuring treatment is finished in the operating theatre. It also gives treatment at the right place and at the right time to the tissues which are at the highest risk of local recurrence.

In a very large international randomised clinical trial of 2,300 patients, half of patients were given target IORT treatment (through random allocation) and the other half were given standard whole breast radiotherapy. It was found that the breast cancer outcomes of local control, distant breast cancer relapse, free survival and breast preservation rates were the same for all patients. However, the deaths from other causes, such as heart attacks, lung problems and other cancers were almost halved in patients undergoing target IORT. In addition, patients with grade 1 and 2 tumours saw an improvement in overall survival of about 4 to 4.5 per cent at 12 years. Other IORT patients had no detriment but rather, an improvement in quality of life, less pain in the postoperative period and a better cosmetic outcome.

IORT is also significantly more convenient and saves journeys of about 750 miles on average per patient, so therefore it also reduces the carbon footprint of cancer treatment. Overall, it’s a win-win situation for the patient because they finish their treatment and have better outcomes. For the healthcare system, the amount of effort that is required for IORT treatment relates just to the operating theatre, as opposed to every day for one to six weeks with postoperative radiotherapy.

How does target IORT enhance patients’ outcomes and contribute to a better quality of life during cancer treatment?

Targeted IORT is given in a single session meaning that patients have to do less travelling to the hospital. It also causes less pain because a lesser part of the breast is irradiated and therefore, patients’ quality of life is improved.

In addition, the cosmetic outcome is better. Surrounding tissues, which don't need radiation, are not given radiation meaning that shrinkage of the breast and similar problems are also reduced. The skin is also protected and skin reactions, which can sometimes occur with radiotherapy, don’t develop. In terms of wound healing, there are no serious concerns because we keep the skin away from the radiation device.
 

How can healthcare providers effectively communicate benefits for patients seeking advanced cancer treatments?

We must remember that targeted intraoperative radiotherapy is given for early breast cancer - tumours that are suitable for breast conserving surgery, of up to about 3 to 3.5cm in size. For advanced breast cancers which require patients to have a mastectomy, this treatment cannot be used. This is communicated through the TARGIT website which contains a lot of relevant information, including video testimonials from patients who have been treated with IORT, as well as numerous newspaper articles on the treatment.

When we want to tell patients about this, we inform them in very clear detail of the associated benefits and risks, including what the evidence tells us in terms of local control, possible potential side effects and so on. With all of this information, the patient is given a choice whether they want to have standard treatment, which has been in use for so many years, or targeted intraoperative radiotherapy, which has now been used for over 25 years.

The first patient was treated with targeted intraoperative radiotherapy in 1998, so it's 25 years since we did the first case. Since the results of the treatment have come out, patients from all over the world have undergone treatment with this technique. There are 260 centres in 35 countries who have offered target IORT to about 50,000 patients. I know this number because they have been in touch to tell me how many patients they have treated. You can go to the TARGIT website to find your closest centre where available.
 

How can healthcare professionals stay informed about the latest research and advancements in cancer treatment?

Healthcare professionals should devote a certain amount of time, at least two to three hours every week, to keep themselves up to date. Most information is now easily available on the web and there are specific websites that they should keep in touch with. They should attend important conferences of the subjects they're interested in so that they can listen to the latest developments and keep themselves up to date with the latest evidence. This is really important so that they can provide their patients with the latest and most advanced, as well as evidence-based, treatment which can improve their length and quality of life.




To schedule a consultation with Professor Vaidya, visit his Top Doctors profile today.