title: Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer.
abstract: BACKGROUND
  We believe that conservative treatment of early breast cancer may not require radiotherapy that encompasses the whole breast. We present here the clinico-pathological basis for this view, as well as a novel therapeutic approach that allows intra-operative radiotherapy to be safely and accurately delivered to the target tissues in a standard operating theatre. THE RATIONALE: Whole-organ analysis of mastectomy specimens reveals that 80% of occult cancer foci are situated remote from the index quadrant. In contrast, over 90% of local recurrences after breast conservative therapy occur near the original tumour, even when radiotherapy is not given. Therefore, the remote occult cancer foci may be clinically irrelevant and radiotherapy to the index quadrant alone might be sufficient. A NOVEL TECHNIQUE: The Photon Radiosurgery System (PRS) is an ingenious portable electron-beam driven device that can typically deliver intra-operative doses of 5-20 Gy, respectively, to 1 cm and 0.2 cm from the tumour bed over about 22 min. The pliable breast tissue--the target--wraps around the source, providing perfect conformal radiotherapy. Being soft X-rays, the dose attenuates rapidly (alpha approximately 1/r3), reducing distant damage.
  
  
  RESULTS
  In our pilot study of 25 patients (age 30-80 years, T = 0.42-4.0 cm), we replaced the routine post-operative tumour bed boost with targeted intra-operative radiotherapy. There have been no major complications and no patient has developed local recurrence, although the median follow-up time is short, at 24 months.
  
  
  CONCLUSIONS
  It is safe and feasible to deliver targeted intraoperative radiotherapy (Targit) for early breast cancer. We have begun a randomised trial--the first of its kind--comparing Targit with conventional six-week course of radiotherapy. If proven equivalent in terms of local recurrence and cosmesis, it could eliminate the need for the usual six-week course of post-operative radiotherapy.
authors.affiliation: Department of Surgery, University College London, UK. j.vaidya@ucl.ac.uk
authors.forename: J S
authors.initials: JS
authors.lastname: Vaidya
authors.forename: M
authors.initials: M
authors.lastname: Baum
authors.forename: J S
authors.initials: JS
authors.lastname: Tobias
authors.forename: D P
authors.initials: DP
authors.lastname: D'Souza
authors.forename: S V
authors.initials: SV
authors.lastname: Naidu
authors.forename: S
authors.initials: S
authors.lastname: Morgan
authors.forename: M
authors.initials: M
authors.lastname: Metaxas
authors.forename: K J
authors.initials: KJ
authors.lastname: Harte
authors.forename: A P
authors.initials: AP
authors.lastname: Sliski
authors.forename: E
authors.initials: E
authors.lastname: Thomson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008408:Mastectomy / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D010865:Pilot Projects; D011878:Radiotherapy / Q000379:methods; D013997:Time Factors