title: Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT.
abstract: To quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks' course of external beam whole breast radiotherapy (EBRT) treatment.
  
  
  
  (1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT.
  
  
  
  485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres.
  
  
  
  The shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy.
  
  
  
  Distances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the non-parametric Wilcoxon rank-sum (Mann-Whitney) test.
  
  
  
  TARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient).
  
  
  
  The use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK.
  
  
  
  ISRCTN34086741; Post-results.
authors.affiliation: Department of Breast Surgery, Great Western Hospital, UK.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Coombs
authors.affiliation: Royal Wootton Bassett Academy, UK.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Coombs
authors.affiliation: Nonsuch High School for Girls, UK Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Uma J
authors.initials: UJ
authors.lastname: Vaidya
authors.affiliation: Department of Radiotherapy, Princess Alexandra Hospital, Harlow, UK.
authors.forename: Julian
authors.initials: J
authors.lastname: Singer
authors.affiliation: Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK University of Notre Dame, Fremantle, Western Australia, Australia.
authors.forename: Max
authors.initials: M
authors.lastname: Bulsara
authors.affiliation: Department of Radiation Oncology(JST), University College London, London, UK.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Tobias
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, Germany.
authors.forename: Frederik
authors.initials: F
authors.lastname: Wenz
authors.affiliation: Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Joseph
authors.affiliation: Ninewells Hospital, Dundee, UK.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Brown
authors.affiliation: Royal Hampshire County Hospital, Winchester, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Rainsbury
authors.affiliation: Royal Free Hospital, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Davidson
authors.affiliation: Ninewells Hospital, Dundee, UK.
authors.forename: Douglas J A
authors.initials: DJ
authors.lastname: Adamson
authors.affiliation: Centro di Riferimento Oncologica, Aviano, Italy.
authors.forename: Samuele
authors.initials: S
authors.lastname: Massarut
authors.affiliation: Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK.
authors.forename: David
authors.initials: D
authors.lastname: Morgan
authors.affiliation: Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Potyka
authors.affiliation: Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
authors.forename: Tammy
authors.initials: T
authors.lastname: Corica
authors.affiliation: Department of Pathology, University College London, London, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Falzon
authors.affiliation: Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Norman
authors.initials: N
authors.lastname: Williams
authors.affiliation: Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Baum
authors.affiliation: Surgical and Interventional Trials Unit of the Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Jayant S
authors.initials: JS
authors.lastname: Vaidya
mesh_terms: D000393:Air Pollutants; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002245:Carbon Dioxide; D019583:Dose Fractionation, Radiation; D005260:Female; D062305:Geographic Mapping; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D007430:Intraoperative Care; D015412:Mastectomy, Segmental; D016032:Randomized Controlled Trials as Topic; D013222:State Medicine; D013997:Time Factors; D014186:Transportation / Q000706:statistics & numerical data*; D006113:United Kingdom; D001335:Vehicle Emissions
chemical_list: D000393:Air Pollutants; D001335:Vehicle Emissions; D002245:Carbon Dioxide
keywords: Breast cancer; IORT; RADIOTHERAPY; TARGIT; targeted intraoperative radiotherapy