Intraoperative radiation therapy (IORT) is one treatment option for early-stage breast cancer.
Due to insufficient evidence supporting its use, the breast cancer experts at John Theurer Cancer Center at Hackensack University Medical Center in New Jersey believe IORT should only be used in the context of a clinical trial, and are therefore not offering this therapy at this time. We’ve assembled this information to help you understand why, and to learn what forms of radiation therapy we offer for breast cancer.
What Is IORT?
IORT for breast cancer (given via either the INTRABEAM® or Axxent® systems) involves the delivery of a single low dose of radiation to the cavity remaining in the breast after lumpectomy, while the patient is still in the operating room. This treatment has been publicized for its convenience and lower cost, compared with standard multiple-dose radiation therapy given over several weeks.
A large study of nearly 3,500 patients in 11 countries, called TARGIT-A (TARGIT stands for “targeted intraoperative radiotherapy”) reported that the estimated risk of cancer recurrence in the breast within five years after treatment was similar between women who received IORT at the same time as lumpectomy (3.3%) and women who had conventional external-beam radiation therapy (1.3%). (Lancet. 2014;383:603-13.) The TARGIT-A researchers concluded that IORT should be considered as a treatment option for eligible patients with breast cancer.
However, there are many concerns in the medical community regarding the design of the TARGIT-A study, the interpretation of its results, the way the radiation is delivered, and the effectiveness of the treatment, among other issues.
Until more data are available and IORT techniques have improved, the 2018 American Society for Radiation Oncology guidelines suggest that IORT for breast cancer be used “only in the setting of a clinical trial”, where patients can be carefully monitored. The doctors at John Theurer Cancer Center agree with ASTRO’s recommendations and are determining whether to open a multicenter IORT clinical trial at our center.