TARGITing Cancer

Radiation administered during breast cancer surgical procedures eliminates the need for patients to return for additional radiotherapy.

by Alicia Di Rado

If USC/Norris Comprehensive Cancer Center specialists have their way, certain women with breast cancer will be able to receive their entire course of radiation therapy in a single treatment—while still under anesthesia during surgery.

USC/Norris is participating in an international, multi-center clinical trial of intraoperative radiotherapy, a technique aimed at women with early stage invasive breast cancers who undergo breast-conserving surgery. The study is called the Targeted Intraoperative Radiotherapy Trial, or TARGIT.

“We believe intraoperative radiotherapy is a tremendous advancement in our ongoing effort to improve the quality of breast cancer treatment, as well as reduce the impact that these treatments have on women’s lives,” says breast surgeon Dennis R. Holmes, M.D., assistant professor of surgery at the Keck School of Medicine of USC.

Holmes is principal investigator on the trial at USC/Norris and is conducting the study with Oscar Streeter Jr., M.D., associate professor of radiation oncology at the Keck School.

Ordinarily, when physicians find invasive breast cancer early—and women have only a single, small tumor and no sign of cancer spread to the lymph nodes—the cancer may be effectively treated first through breast-conserving surgery, called a lumpectomy, and then through follow-up radiation therapy.

The traditional external-beam radiation therapy requires treatment five days a week for six to seven weeks at a medical center, which may be daunting for women with transportation limitations and family and job demands.

“But with intraoperative radiotherapy, radiation is administered during the surgical procedure, avoiding the need to return for additional radiotherapy,” Holmes explains. “It takes 20 to 35 minutes to administer, after the tumor has been removed.”

Intraoperative radiotherapy begins with a special wand—featuring a round, gold tip—that is attached to the arm of a machine next to the operating table. While the patient is still under anesthesia, physicians position the gold tip inside the cavity left by the removed tumor. The wand accelerates electrons and sends them through the gold tip, emitting X-rays into the tissues immediately surrounding the tumor cavity, where the risk of cancer recurrence is greatest.

After the radiation is administered, surgeons close the incision as they normally would, while pathologists check the tumor’s margins to ensure full removal.

TARGIT aims to find out if intraoperative radiotherapy is as effective as traditional external-beam radiation. Women eligible to participate in the trial will be randomly assigned to either a group receiving lumpectomy and intraoperative radiotherapy, or a group receiving lumpectomy and traditional external-beam radiation. Women chosen for external-beam radiation may have it done at USC/Norris or at another hospital near their home.

Initial European studies indicate intraoperative radiotherapy has similar side effects and effectiveness as external-beam radiation. Women must be monitored regularly after treatment. USC/Norris researchers aim to recruit 200 women for the trial. For more information about TARGIT, visit www.targittrial.com or call (323) 865-3933.