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Piroth MD, Strnad V, Krug D, Fastner G, Baumann R, Combs SE, Duma MN, Dunst J, Feyer P, Fietkau R, Haase W, Harms W, Hehr T, Sedlmayer F, Souchon R, Budach W. Long-Term Results of the TARGIT-A Trial: More Questions than Answers. Breast Care (Basel) 2022; 17:81-84. [PMID: 35355706 PMCID: PMC8914270 DOI: 10.1159/000515386] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/20/2021] [Indexed: 02/03/2023] Open
Abstract
Background During the last decade, partial breast irradiation (PBI) has gained traction as a relevant treatment option for patients with early-stage low-risk breast cancer after breast-conserving surgery. The TARGIT-A prospective randomized trial compared a "risk-adapted" intraoperative radiotherapy (IORT) approach with 50-kv X-rays (INTRABEAM®) as the PBI followed by optional whole-breast irradiation (WBI) and conventional adjuvant WBI in terms of observed 5-year in-breast recurrence rates. Recently, long-term data were published. Since the first publication of the TARGIT-A trial, a broad debate has been emerged regarding several uncertainties and limitations associated with data analysis and interpretation. Our main objective was to summarize the data, with an emphasis on the updated report and the resulting implications. Summary From our point of view, the previously unresolved questions still remain and more have been added, especially with regard to the study design, a change in the primary outcome measure, the significant number of patients lost to follow-up, and the lack of a subgroup analysis according to risk factors and treatment specifications. Key Message Taking into account the abovementioned limitations of the recently published long-term results of the TARGIT-A trial, the German Society of Radiation Oncology (DEGRO) Breast Cancer Expert Panel adheres to its recently published recommendations on PBI: "the 50-kV system (INTRABEAM) cannot be recommended for routine adjuvant PBI treatment after breast-conserving surgery."
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Affiliation(s)
- Marc D. Piroth
- Department of Radiation Oncology, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, University Hospital, Erlangen, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Gerd Fastner
- Department of Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - René Baumann
- Department of Radiation Oncology, St. Marien-Krankenhaus, Siegen, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), München, Germany
| | - Marciana Nona Duma
- Department of Radiation Oncology, Friedrich-Schiller-University Hospital, Jena, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Petra Feyer
- Department of Radiation Oncology, Vivantes Hospital Neukoelln, Berlin, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital, Erlangen, Germany
| | - Wulf Haase
- Formerly St.-Vincentius-Hospital Karlsruhe, Karlsruhe, Germany
| | - Wolfgang Harms
- Department of Radiation Oncology, St. Claraspital, Basel, Switzerland
| | - Thomas Hehr
- Department of Radiation Oncology, Marienhospital, Stuttgart, Germany
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | | | - Wilfried Budach
- Department of Radiation Oncology, Heinrich-Heine-University Hospital, Düsseldorf, Germany
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