New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer

被引：36

作者：

Vaidya, Jayant S. ^{[1
]}

Bulsara, Max ^{[2
]}

Baum, Michael ^{[1
]}

Wenz, Frederik ^{[3
]}

Massarut, Samuele ^{[4
]}

Pigorsch, Steffi ^{[5
]}

Alvarado, Michael ^{[6
]}

Douek, Michael ^{[7
]}

Saunders, Christobel ^{[8
]}

Flyger, Henrik ^{[9
]}

Eiermann, Wolfgang ^{[10
]}

Brew-Graves, Chris ^{[1
]}

Williams, Norman R. ^{[1
]}

Potyka, Ingrid ^{[1
]}

Roberts, Nicholas ^{[1
]}

Bernstein, Marcelle ^{[11
]}

Brown, Douglas ^{[12
]}

Sperk, Elena ^{[3
]}

Laws, Siobhan ^{[13
]}

Suetterlin, Marc ^{[14
]}

Corica, Tammy ^{[15
]}

Lundgren, Steinar ^{[16
,17
]}

Holmes, Dennis ^{[18
,19
]}

Vinante, Lorenzo ^{[20
]}

Bozza, Fernando ^{[21
]}

Pazos, Montserrat ^{[22
]}

Le Blanc-Onfroy, Magali ^{[23
]}

Gruber, Guenther ^{[24
]}

Polkowski, Wojciech ^{[25
]}

Dedes, Konstantin J. ^{[26
]}

Niewald, Marcus ^{[27
]}

Blohmer, Jens ^{[28
,29
]}

McReady, David ^{[30
]}

Hoefer, Richard ^{[31
]}

Kelemen, Pond ^{[32
]}

Petralia, Gloria ^{[33
]}

Falzon, Mary ^{[34
]}

Joseph, David ^{[15
]}

Tobias, Jeffrey S. ^{[35
]}

机构：

[1] UCL, Div Surg & Intervent Sci, London, England

[2] Univ Notre Dame, Dept Biostat, Fremantle, WA, Australia

[3] Heidelberg Univ, Univ Med Ctr Mannheim, Med Fac Mannheim, Dept Radiat Oncol, Mannheim, Germany

[4] IRCCS, Ctr Riferimento Oncol Aviano, Dept Surg, CRO, Aviano, Italy

[5] Tech Univ Munich, Red Cross Hosp, Dept Radiat Oncol, Munich, Germany

[6] Univ Calif San Francisco, Dept Surg, San Francisco, CA 94143 USA

[7] Univ Oxford, Nuffield Dept Surg Sci, Oxford, England

[8] Univ Western Australia, Sch Surg, Perth, WA, Australia

[9] Univ Copenhagen, Dept Breast Surg, Copenhagen, Denmark

[10] Tech Univ Munich, Red Cross Hosp, Dept Gynecol & Obstet, Munich, Germany

[11] Patient Advocate & Writer, London, England

[12] Ninewells Hosp, Dept Surg, Dundee, Scotland

[13] Royal Hampshire Cty Hosp, Dept Surg, Winchester, Hants, England

[14] Heidelberg Univ, Univ Med Ctr Mannheim, Med Fac Mannheim, Dept Gynecol & Obstet, Berlin, Germany

[15] Sir Charles Gairdner Hosp, Dept Radiat Oncol, Perth, WA, Australia

[16] Norwegian Univ Sci & Technol NTNU, Dept Oncol, St Olavs Univ Hosp, Trondheim, Norway

[17] Norwegian Univ Sci & Technol NTNU, Dept Clin & Mol Med, Trondheim, Norway

[18] Univ Southern Calif, John Wayne Canc Inst, Los Angeles, CA USA

[19] Univ Southern Calif, Helen Rey Breast Canc Fdn, Los Angeles, CA USA

[20] Ctr Riferimento Oncol Aviano, Dept Radiat Oncol, IRCCS, Aviano, Italy

[21] IRCCS, Inst Oncol Veneto, Dept Surg, Padua, Italy

[22] Ludwig Maximilians Univ Munchen, Univ Hosp, Dept Radiat Oncol, Munich, Germany

[23] Inst Cancerol Ouest, Oncol Radiotherapeute, Nantes, France

[24] Brust Zentrum Seefeld, Zurich, Switzerland

[25] Med Univ Lublin, Dept Surg Oncol, Lublin, Poland

[26] Univ Spital Zurich, Breast Ctr, Zurich, Switzerland

[27] Saarland Univ, Med Ctr, Homburg, Germany

[28] Sankt Gertrauden Krankenhaus, Berlin, Germany

[29] Charite Univ Med Berlin, Berlin, Germany

[30] Princess Margaret Canc Ctr, Toronto, ON, Canada

[31] Sentara Surg Specialists, Hampton, VA USA

[32] New York Med Coll, Ashikari Breast Ctr, New York, NY USA

[33] Univ Coll London Hosp, Dept Surg, London, England

[34] Univ Coll London Hosp, Dept Pathol, London, England

[35] Univ Coll London Hosp, Dept Clin Oncol, London, England

来源：

BRITISH JOURNAL OF CANCER | 2021年 / 125卷 / 03期

基金：

英国医学研究理事会;

关键词：

MULTICENTRICITY; IMPAIRS;

D O I：

10.1038/s41416-021-01440-8

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

BACKGROUND: The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. METHODS: In total, 2298 women (>= 45 years, invasive ductal carcinoma <= 3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. RESULTS: Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091. CONCLUSION: TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect.

引用

页码：380 / 389

页数：10

共 29 条

[1]

Abe O, 2005, LANCET, V366, P2087, DOI 10.1016/s0140-6736(05)66544-0

[2] Multicentricity and recurrence of breast cancer [J].

Baum, M ;

Vaidya, JS ;

Mittra, I .

LANCET, 1997, 349 (9046) :208-208

[3] Targeted intraoperative radiotherapy impairs the stimulation of breast cancer cell proliferation and invasion caused by surgical wounding [J].

Belletti, Barbara ;

Vaidya, Jayant S. ;

D'Andrea, Sara ;

Entschladen, Frank ;

Roncadin, Mario ;

Lovat, Francesca ;

Berton, Stefania ;

Perin, Tiziana ;

Candiani, Ezio ;

Reccanello, Sonia ;

Veronesi, Andrea ;

Canzonieri, Vincenzo ;

Trovo, Mauro G. ;

Zaenker, Kurt S. ;

Colombatti, Alfonso ;

Baldassarre, Gustavo ;

Massarut, Samuele .

CLINICAL CANCER RESEARCH, 2008, 14 (05) :1325-1332

[4] Stereotactic Ablative Radiotherapy Combined with Immune Checkpoint Inhibitors Reboots the Immune Response Assisted by Immunotherapy in Metastatic Lung Cancer: A Systematic Review [J].

Chicas-Sett, Rodolfo ;

Morales-Orue, Ignacio ;

Castilla-Martinez, Juan ;

Zafra-Martin, Juan ;

Kannemann, Andrea ;

Blanco, Jesus ;

Lloret, Marta ;

Lara, Pedro C. .

INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES, 2019, 20 (09)

[5] Intraoperative radiotherapy (IORT) for surgically resected brain metastases: outcome analysis of an international cooperative study [J].

Cifarelli, Christopher P. ;

Brehmer, Stefanie ;

Vargo, John Austin ;

Hack, Joshua D. ;

Kahl, Klaus Henning ;

Sarria-Vargas, Gustavo ;

Giordano, Frank A. .

JOURNAL OF NEURO-ONCOLOGY, 2019, 145 (02) :391-397

[6]

Darby SC, 2013, NEW ENGL J MED, V368, P2527

[7] Guidelines for time-to-event end point definitions in breast cancer trials: results of the DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials) [J].

Gourgou-Bourgade, S. ;

Cameron, D. ;

Poortmans, P. ;

Asselain, B. ;

Azria, D. ;

Cardoso, F. ;

A'Hern, R. ;

Bliss, J. ;

Bogaerts, J. ;

Bonnefoi, H. ;

Brain, E. ;

Cardoso, M. J. ;

Chibaudel, B. ;

Coleman, R. ;

Cufer, T. ;

Dal Lago, L. ;

Dalenc, F. ;

De Azambuja, E. ;

Debled, M. ;

Delaloge, S. ;

Filleron, T. ;

Gligorov, J. ;

Gutowski, M. ;

Jacot, W. ;

Kirkove, C. ;

MacGrogan, G. ;

Michiels, S. ;

Negreiros, I. ;

Offersen, B. V. ;

Llorca, F. Penault ;

Pruneri, G. ;

Roche, H. ;

Russell, N. S. ;

Schmitt, F. ;

Servent, V. ;

Thuerlimann, B. ;

Untch, M. ;

van der Hage, J. A. ;

van Tienhoven, G. ;

Wildiers, H. ;

Yarnold, J. ;

Bonnetain, F. ;

Mathoulin-Pelissier, S. ;

Bellera, C. ;

Dabakuyo-Yonli, T. S. .

ANNALS OF ONCOLOGY, 2015, 26 (05) :873-879

[8] Radiobiological aspects of intraoperative tumour-bed irradiation with low-energy X-rays (LEX-IORT) [J].

Herskind, Carsten ;

Wenz, Frederik .

TRANSLATIONAL CANCER RESEARCH, 2014, 3 (01) :3-17

[9]

Houghton, 1999, TARGETED INTRAOPERAT

[10] Proposal for standardized definitions for efficacy end points in adjuvant breast cancer trials: The STEEP system [J].

Hudis, Clifford A. ;

Barlow, William E. ;

Costantino, Joseph P. ;

Gray, Robert J. ;

Pritchard, Kathleen I. ;

Chapman, Judith-Anne W. ;

Sparano, Joseph A. ;

Hunsberger, Sally ;

Enos, Rebecca A. ;

Gelber, Richard D. ;

Zujewski, Jo Anne .

JOURNAL OF CLINICAL ONCOLOGY, 2007, 25 (15) :2127-2132

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