Vaidya, JS;
Williams, NR;
Bulsara, M;
Baum, M;
Brew-Graves, C;
Potyka, I;
Roberts, N;
... Tobias, JS; + view all
(2025)
Long-term incidence of lung cancer in the TARGIT-A randomised trial of targeted intraoperative radiotherapy for breast cancer.
Presented at: 44th European Society of Surgical Oncology Annual Congress, Gothenburg, Sweden.
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Abstract
Background: With improvement in survival after breast cancer, the burden and longer-term side effects of treatment are increasingly relevant. Today, most patients can avoid a mastectomy, but having a breast conserving surgery is traditionally followed by external beam whole breast radiotherapy (EBRT), which can be onerous and leads to inevitable and potentially carcinogenic irradiation of nearby vital organs such as the lungs. The results of the TARGIT-A randomised trial found that TARGIT-IORT during the initial lumpectomy is as effective as EBRT in controlling breast cancer, and has several benefits to the patient including reduced pain, improved cosmetic outcome and quality of life, and significantly fewer deaths from non-breast-cancer causes, leading to an overall survival benefit in patients with grade 1 or 2 cancers with a 12-year mortality reduction from 15% to 10.5%. / Material and methods: We collected long term data about health status and new cancer diagnoses of UK patients from the TARGIT-A randomised trial, using direct patient contact, & NHS Digital data. We compared lung cancer incidence between patients randomised to TARGIT-IORT vs EBRT. / Results: The length of follow up of UK patients (n=714) increased to a median of 14 years (IQR 13 to 16) There were significantly more lung cancer diagnoses in the EBRT arm compared with TARGIT-IORT arm; HR 3.3 (95%CI 1.1 – 10.2). The 16-year incidences were: EBRT: 7.2% (95%CI 3.7 – 13.7) and TARGIT: 1.8% (95%CI 0.6-5.2), difference 5.38% (95%CI 0.3 -10.5), log rank p=0.0266. An estimated 920000 breast cancer patients worldwide are suitable for TARGIT-IORT annually. Using the 5.38% reduction in lung cancer risk that we have observed, if TARGIT-IORT were to be made accessible to these patients, then 49496 (95%CI 5500-134320) of these patients would be spared the diagnosis of a lung cancer during their follow up. / Conclusions: With very long-term follow data from of a large TARGIT-A randomised trial, we found a substantial increase in lung cancer incidence with EBRT compared with TARGIT-IORT. It is a tragedy when women who outlive breast cancer then succumb to this frequently lethal radiation-induced lung cancer, which is avoidable by using TARGIT-IORT during lumpectomy instead of post-operative EBRT. These new data further mandate full discussion about benefits of TARGIT-IORT with patients, including reduction in lung cancer incidence, before their surgery.
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