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Intraoperative Radiotherapy

Dennis R. Holmes, M.D., F.A.C.S. -  - Breast Cancer Surgeon

Dennis R. Holmes, M.D., F.A.C.S.

Breast Cancer Surgeon located in Los Angeles, CA and Glendale, CA

As National Co-Chair of the TARGIT U.S. Registry clinical trial and former President of the TARGIT Collaborative Group, breast surgeon Dennis R. Holmes, M.D., F.A.C.S., is a world-recognized expert in targeted intraoperative radiotherapy (TARGIT) with offices in Glendale, California.

Intraoperative Radiotherapy Q & A

What is targeted intraoperative radiotherapy?

TARGeted Intraoperative radioTherapy (TARGIT) or IORT is a form of partial breast radiation that is administered to the walls of a lumpectomy cavity as a single treatment to reduce the risk of cancer recurrence. As a type of partial breast radiation, TARGIT limits the radiation treatment to the tumor site where the risk of recurrence is highest. This spares the rest of the breast and surrounding tissues (e.g., heart and lung) the side effects of radiation. TARGIT usually takes less than 30 minutes to administer. By comparison, traditional whole breast radiotherapy administers radiation to the whole breast and chest wall after recovering from surgery, and takes several weeks to complete.




What are the advantages of TARGIT versus traditional radiotherapy?

For most patients, TARGIT completely eliminates the needs for the prolonged course of whole breast radiation that is typically required after lumpectomy.

Also, TARGIT reduces the overall side effects of radiation by confining the radiation dose to the part of the breast from which the cancer was removed, sparing the rest of the breast and surrounding tissues (e.g., heart and lung) the side effects of radiation.  However, TARGIT is not the right solution for all lumpectomy patients. Patients with large tumors or positive lymph nodes still benefit from whole breast radiation to reduce the risk of recurrence in the breast and/or lymph node area. .

Is TARGIT an effective treatment for breast cancer?

The effectiveness of TARGIT was investigated in an international study called the TARGIT-“A” Trial, a clinical trial that compared single dose partial breast targeted intraoperative radiotherapy (IORT) to 3-6 week-course of post-operative whole breast radiotherapy.  All participants underwent lumpectomy for early-stage breast cancer. The result of the clinical trial publication, which Dr. Holmes co-authored, demonstrated equal breast cancer recurrence rates and equal cancer survival rates among recipients of TARGIT compared to those receiving radiation after surgery. The paper was published today in the British Medical Journal.

With long term follow-up (median 8.6 years, maximum 18.9 years), the TARGIT-“A” Trial demonstrated no significant difference in the 5-year local recurrence rates and 8.6 year local-recurrence free survival rate, breast cancer survival rate, and overall survival rate. Women receiving TARGIT had a significantly lower risk of dying from other causes (e.g., heart disease or cancers). The findings of the TARGIT-A trial are summarized in the following table:


Additional advantages of TARGIT include

  1. TARGIT is a convenient one stop treatment. Lumpectomy and radiation are completed in one visit to the hospital.
  2. TARGIT has less radiation exposure to the lungs and heart.
  3. TARGIT has significantly less side effects on the breast, including less injury to the skin and no radiation-induced breast shrinkage
  4. TARGIT is a patient centered treatment that eliminates the need for women to find time away from work, childcare, and/or homecare as required for other forms of breast radiation that must be administered over multiple days or multiple weeks.
  5. TARGIT eliminates the financial burden of prolonged radiation treatments for those who do not have a car or money for gas, share ride, a taxi, or a job that gives them the freedom to take time away from work.
  6. TARGIT has superior cosmetic results for women with breast implants who are at greater risk of having poor cosmetic results from whole breast radiation.
  7. TARGIT reduces the physical burden of radiation for women with physical limitations or mobility challenges.
  8. TARGIT makes it easier for women living in remote locations to preserve their breast rather than undergo mastectomy because that cannot commit to a longer course of radiation.
  9. TARGIT does not prevent a woman from also safely receiving the traditional 4–6-week course of whole breast radiation after surgery if final surgical pathology results reveal unexpected high-risk findings most suitable for TARGIT alone.
  10. TARGIT reduces the burden of radiotherapy by providing an effective, safer, and more convenient radiation treatment option for women who do not require whole breast radiation.


Am I a candidate for TARGIT?

If you’ve been diagnosed with breast cancer and are considering a lumpectomy, you may be eligible for TARGIT if you meet the following criteria:

  • Age 40 or older have breast cancer in only one part of the breast
  • Have breast cancer treatable with lumpectomy
  • Have a tumor that is 3 cm (1.5 inches) or smaller
  • Don’t have any signs of cancer in the lymph nodes
  • Have stage 0, 1 or early stage II breast

For more information about intraoperative radiotherapy, visit Dr. Holmes’s YouTube Channel here