TARGIT - IORT

Intrabeam TARGIT IORT is targeted intraoperative radiotherapy treatment for breast cancer. Conceived in the UK more than 20 years ago, thoroughly tested in clinical trials, TARGIT IORT treatment is widely used to treat breast cancer patients across the world.
“The most important benefit of TARGIT for a woman with breast cancer is that it allows her to complete her entire local treatment [lumpectomy and radiation therapy] at the time of her operation, with lower toxicity.” Lancet 2014;383:603-613
Please visit the dedicated website for TARGIT-IORT
Special relevance of TARGIT-IORT during the COVID-19 pandemic
TARGIT-IORT is given as a single dose during the cancer operation - so in most patients no visits to the radiotherapy department are required. This is especially relevant during the COVID-19 pandemic. When the radiotherapy is completed during the cancer operation, under the same anaesthetic, it greatly reduces the need for repeated post-operative visits to the hospital for postoperative external beam radiotherapy which are necessary for regimens such as IMPORT-Low or Fast-Forward which irradiates the whole breast.
This is why it has been included in several national and international guidelines for treatment of breast cancer during the COVID-19 pandemic caused by the widespread infection with the SARS-CoV-2 virus
During the COVID-19 pandemic, new guidelines for treatment of beast cancer and radiotherapy have recommend using TARGIT-IORT because it would save patients the daily travel (and viral exposure) to radiotherapy departments:
Global radiation oncology's targeted preparedness for COVID-19
https://www.sciencedirect.com/science/article/pii/S2405630820300227
“where the technology is available the use of IORT may obviate the need for any further outpatient treatment and should be considered an option ..”
British Association of Cancer Surgery (BASO~ACS) https://baso.org.uk/media/98159/covid_19_and_breast_cancer_march_2020.pdf
German University Hospitals
https://ro-journal.biomedcentral.com/articles/10.1186/s13014-020-01527-1
Italian Association of Radiotherapy and Clinical Oncology
https://www.thegreenjournal.com/article/S0167-8140(20)30221-8/fulltext
China is increasing its use of TARGIT-IORT #breastcancer by equipping more centres with the TARGIT-IORT equipment
Click here to see the national and international guidelines recommending TARGIT-IORT for breast cancer
Information about Intrabeam TARGIT IORT
Why is radiotherapy used for breast cancer?
Breast cancer is frequently treated by surgically removing the cancerous lump with a margin of surrounding normal tissue. Radiotherapy to the remaining breast after such a lumpectomy reduces the risk of cancer coming back in the breast. Traditional external beam radiotherapy (EBRT) is given to the whole breast a few weeks after surgical removal of the cancer. As it is not focused, it needs to be given in daily small doses over three to six weeks.
What is Intraoperative radiotherapy | Intrabeam | TARGIT | IORT for breast cancer?
What is the surgical procedure of giving TARGIT IORT?
TARGIT IORT is given using the Intrabeam device. It is given during your surgery, while you remain asleep, under general anaesthetic. It adds about 30 minutes to the operation.
Has TARGIT IORT been clinically tested for breast cancer?
What will it involve?
Who can and cannot have TARGIT IORT?
Women who are 45 or older with invasive ductal type cancer suitable for breast conservation (tumour size up to 3.5cm) are eligible to receive TARGIT IORT instead of EBRT. Other women who have a higher risk cancer can receive TARGIT as a tumour-bed boost in addition to EBRT within the TARGIT-B trial. Women who need a mastectomy are not suitable.
Key Benefits of Intrabeam TARGIT IORT
Key Concerns about Intrabeam TARGIT IORT
NICE Recommendation
Intrabeam TARGIT IORT for breast cancer is clinically effective - confirmed in the TARGIT-A international clinical trial


First publication of the main results (2010)
Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial.
The Lancet. 2010 ;376(9735):91-102.
5-year results and first analysis of survival (2014)
Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial.
The Lancet. 11 November 2013. doi:10.1016/s0140-6736(13)61950-9
Full 226 page report of the TARGIT-A trial of Intrabeam TARGIT IORT for HTA, NIHR, Department of Health, UK (2016)
An international randomised controlled trial to compare TARGeted Intraoperative radioTherapy (TARGIT) with conventional postoperative radiotherapy after breast-conserving surgery for women with early-stage breast cancer (the TARGIT-A trial).
Health Technology Assessment 2016;20(73)
Long term outcomes of the TARGIT-A trial (2020)
Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2836 (Published 19 August 2020)
Recent peer reviewed publications are below: more are available here
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Red Journal: Meta-analyis Improved survival with targeted radiotherapy
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Lancet: Updated meta-analysis of targeted radiotherapy confirming the survival benefit
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Lancet: A meta-analysis of the GEC-ESTRO and the TARGIT-A: 5 year data
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BMJ Open: Environmental and Social benefits of Intrabeam TARGIT IORT
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Red Journal: Better breast-related quality of life with TARGIT IORT
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NIHR Journals: Cost-Utility analysis of TARGIT IORT - Saving £9 million/yr in thUK
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BMJ Open: Health Economics of TARGIT-IORT: Less costly for NHS
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Breast Care: A tumour bed boost after neoadjuvant chemotherapy
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BMJ Evidence Based Medicine: commentary on the IMPORT-LOW trial
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PRO: Commentary and corrections to the 2017 ASTRO APBI consensus
Surgical technique video of TARGIT IORT for breast cancer
iPhone App for helping to choose TARGIT for appropriate breast cancer patients. Android version
The TARGIT-A trial of intraoperative radiotherapy for breast cancer
How was TARGIT IORT for breast cancer developed?
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The TARGIT technique uses the Intrabeam device for delivering precise and timely dose of intraoperative radiotherapy accurately to the tumour bed.
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An academic insight led to the development of this device through a collaborative effort between University College London and the Photoelectron Corporation in 1990s.
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It was first used on 2 July 1998 in the Middlesex Hospital, UCL, London. Intrabeam is currently manufactured by Carl Zeiss
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The Intrabeam TARGIT IORT method has been rigorously tested in the ransomised TARGIT-A trial in which 3451 patients from 33 centres in 11 countries participated. Intrabeam TARGIT IORT given during the cancer operation was compared with the traditional radiation therapy given daily over several weeks after the operation.
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Currently, breast cancer centres in over 300 hospitals in 38 countries offer Intrabeam TARGIT IORT to suitable patients
What was done in the TARGIT-A trial?
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The TARGIT-A trial was a randomised trial testing an individualised approach of radiation after lumpectomy for breast cancer.
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The comparison in the TARGIT-A trial was between standard radiation therapy that is given over several weeks after a lumpectomy vs. a risk-adapted approach using single dose of TARGeted Intraoperative radioTherapy (TARGIT) using Intrabeam given at the time of lumpectomy.
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The risk-adapted protocol recommended that if the patients who had received TARGIT IORT with Intrabeam were found to have high risk factors postoperatively, they also received whole breast radiation – which occurred in 15-20% of cases as expected in the protocol; otherwise, about 80% of such patients completed their treatment (surgery and radiation) during their lumpectomy.
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The pre-specified non-inferiority margin was an absolute difference in local recurrence of breast cancer between TARGIT and EBRT of 2.5% — in simple terms, if the absolute difference in local recurrence between the two treatments being compared was less than 2.5%, they would be considered non-inferior to each other in terms of local control of breast cancer. Patient preference studies have suggests majority of patients consider such a 2.5% margin as appropriate.
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3451 patients from 33 centres in 11 countries participated in the TARGIT-A trial (UK, USA, Germany, Italy, France Poland , Switzerland, Norway, Denmark, Canada and Australia) from 24 March 2000 to 25 June 2012. ( map).
How is TARGIT IORT given during surgery?
TARGIT IORT is given using the Intrabeam device. It is given during your surgery, while you remain asleep, under general anaesthetic. It adds about 30 minutes to the operation.
Is Intrabeam TARGIT IORT Effective?
Which patients could have taken part in the TARGIT-A trial
TARGIT-A Trial Design
Design of the two parallel trials of immediate and delayed TARGIT-IORT
What was found? Results of the TARGIT-A trial
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When TARGIT is given with lumpectomy, the 5-year local recurrence of breast cancer is similar to EBRT
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When TARGIT is given as a second procedure, the difference in local recurrence between TARGIT and EBRT was more than 2.5%
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Breast cancer mortality with TARGIT were similar to EBRT
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Mortality from other causes was significantly lower with TARGIT due to fewer deaths from cardiovascular causes and other cancers.
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The results remain stable with longer follow up. The results were the same for the large number (1222) patients who were treated between 2000-2008 and had a median follow up of 5 years.
Some scientific publications related TARGIT-A trial