title: Targeted intraoperative radiotherapy for breast cancer in patients in whom external beam radiation is not possible.
abstract: OBJECTIVE
  External beam radiation therapy (EBRT) following wide local excision of the primary tumor is the standard treatment in early breast cancer. In some circumstances this procedure is not possible or is contraindicated or difficult. The purpose of this study was to determine the safety and efficacy of targeted intraoperative radiotherapy (TARGIT) when EBRT is not feasible.
  
  
  METHODS
  We report our experience with TARGIT in three centers (Australia, Germany, and the United Kingdom) between 1999 and 2008. Patients at these centers received a single radiation dose of 20 Gy to the breast tissue in contact with the applicator (or 6 Gy at 1-cm distance), as they could not be given EBRT and were keen to avoid mastectomy.
  
  
  RESULTS
  Eighty patients were treated with TARGIT. Reasons for using TARGIT were 21 patients had previously received EBRT, and 31 patients had clinical reasons such as systemic lupus erythematosus, motor neuron disease, Parkinson's disease, ankylosing spondylitis, morbid obesity, and cardiovascular or severe respiratory disease. Three of these patients received percutaneous radiotherapy without surgery; 28 patients were included for compelling personal reasons, usually on compassionate grounds. After a median follow-up of 38 months, only two local recurrences were observed, an annual local recurrence rate of 0.75% (95% confidence interval, 0.09%-2.70%).
  
  
  CONCLUSIONS
  While we await the results of the randomized trial (over 2,000 patients have already been recruited), TARGIT is an acceptable option but only in highly selected cases that cannot be recruited in the trial and in whom EBRT is not feasible/possible.
authors.affiliation: Royal Free and University College Medical School, University College London/University College Hospital, London, United Kingdom. m.keshtgar@ucl.ac.uk
authors.forename: Mohammed R S
authors.initials: MR
authors.lastname: Keshtgar
authors.forename: Jayant S
authors.initials: JS
authors.lastname: Vaidya
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Tobias
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.forename: David
authors.initials: D
authors.lastname: Joseph
authors.forename: Chris
authors.initials: C
authors.lastname: Stacey
authors.forename: Marinos G
authors.initials: MG
authors.lastname: Metaxas
authors.forename: Anke
authors.initials: A
authors.lastname: Keller
authors.forename: Tammy
authors.initials: T
authors.lastname: Corica
authors.forename: Norman R
authors.initials: NR
authors.lastname: Williams
authors.forename: Michael
authors.initials: M
authors.lastname: Baum
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000075202:Contraindications; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011878:Radiotherapy / Q000379:methods; D047368:Tumor Burden; D006113:United Kingdom