Target IORT: Intraoperative radiotherapy for breast cancer

Written by: Professor Jayant Vaidya
Edited by: Sophie Kennedy

In this informative article, Professor Jayant Vaidya, a leading consultant oncoplastic breast surgeon and professor of surgery, sheds light on targeted intraoperative radiotherapy, also known as target IORT, and its applications in the treatment of breast cancer. The highly respected specialist discusses how the treatment is applied and which types of breast cancer are suitable for this form of radiotherapy. Additionally, Professor Vaidya shares his expert insight on the benefits of target IORT as evidenced by international study data.

What makes target IORT stand out in cancer radiotherapy and how does it improve treatment effectiveness?

Targeted intraoperative radiotherapy, or target IORT, is unique in many ways. It was conceived based on the biological fact that when a cancer is treated by with a lumpectomy, it recurs in a small proportion of people and seems to come back around the site of the tumour. Even though there may be microscopic tumours in other parts of the breast, they don't seem to grow.

Therefore, at UCL, we devised a technique of giving radiation only around the tumour bed after the cancer is removed. This is target IORT, performed in collaboration with Carl Zeiss. The radiotherapy is given immediately after the cancer is removed. While the patient is still asleep under the same anaesthetic, a radiotherapy device is inserted into the tumour bed for about 20 to 25 minutes. Once it has been taken out, the breast is closed and sutured, meaning the whole treatment is finished in one go.

This is highly convenient for the patient, avoiding a postoperative course of radiotherapy which can take weeks of daily treatments, and ensuring treatment is finished in the operating theatre. It also gives treatment at the right place and at the right time to the tissues which are at the highest risk of local recurrence.

In a very large international randomised clinical trial of 2,300 patients, half of patients were given target IORT treatment (through random allocation) and the other half were given standard whole breast radiotherapy. It was found that the breast cancer outcomes of local control, distant breast cancer relapse, free survival and breast preservation rates were the same for all patients. However, the deaths from other causes, such as heart attacks, lung problems and other cancers were almost halved in patients undergoing target IORT. In addition, patients with grade 1 and 2 tumours saw an improvement in overall survival of about 4 to 4.5 per cent at 12 years. Other IORT patients had no detriment but rather, an improvement in quality of life, less pain in the postoperative period and a better cosmetic outcome.

IORT is also significantly more convenient and saves journeys of about 750 miles on average per patient, so therefore it also reduces the carbon footprint of cancer treatment. Overall, it’s a win-win situation for the patient because they finish their treatment and have better outcomes. For the healthcare system, the amount of effort that is required for IORT treatment relates just to the operating theatre, as opposed to every day for one to six weeks with postoperative radiotherapy.


How does target IORT enhance patients’ outcomes and contribute to a better quality of life during cancer treatment?

Targeted IORT is given in a single session meaning that patients have to do less travelling to the hospital. It also causes less pain because a lesser part of the breast is irradiated and therefore, patients’ quality of life is improved.

In addition, the cosmetic outcome is better. Surrounding tissues, which don't need radiation, are not given radiation meaning that shrinkage of the breast and similar problems are also reduced. The skin is also protected and skin reactions, which can sometimes occur with radiotherapy, don’t develop. In terms of wound healing, there are no serious concerns because we keep the skin away from the radiation device.

How can healthcare providers effectively communicate benefits for patients seeking advanced cancer treatments?

We must remember that targeted intraoperative radiotherapy is given for early breast cancer - tumours that are suitable for breast conserving surgery, of up to about 3 to 3.5cm in size. For advanced breast cancers which require patients to have a mastectomy, this treatment cannot be used. This is communicated through the TARGIT website which contains a lot of relevant information, including video testimonials from patients who have been treated with IORT, as well as numerous newspaper articles on the treatment.

When we want to tell patients about this, we inform them in very clear detail of the associated benefits and risks, including what the evidence tells us in terms of local control, possible potential side effects and so on. With all of this information, the patient is given a choice whether they want to have standard treatment, which has been in use for so many years, or targeted intraoperative radiotherapy, which has now been used for over 25 years.

The first patient was treated with targeted intraoperative radiotherapy in 1998, so it's 25 years since we did the first case. Since the results of the treatment have come out, patients from all over the world have undergone treatment with this technique. There are 260 centres in 35 countries who have offered target IORT to about 50,000 patients. I know this number because they have been in touch to tell me how many patients they have treated. You can go to the TARGIT website to find your closest centre where available.

How can healthcare professionals stay informed about the latest research and advancements in cancer treatment?

Healthcare professionals should devote a certain amount of time, at least two to three hours every week, to keep themselves up to date. Most information is now easily available on the web and there are specific websites that they should keep in touch with. They should attend important conferences of the subjects they're interested in so that they can listen to the latest developments and keep themselves up to date with the latest evidence. This is really important so that they can provide their patients with the latest and most advanced, as well as evidence-based, treatment which can improve their length and quality of life.

To schedule a consultation with Professor Vaidya, visit his Top Doctors profile today.

By Professor Jayant Vaidya

Professor Jayant Vaidya is a prominent consultant oncoplastic breast surgeon and professor of surgery based in London, specialising in the diagnosis and treatment of diseases of the breast. With over 25 years of experience, Professor Vaidya is highly experienced in a wide range of treatments. His areas of expertise include breast cancer, lumpectomy, targeted intraoperative radiotherapy, mastectomy, breast preserving surgery and breast abscess, while his areas of surgical oncology expertise include sentinel node biopsy and intraoperative radiotherapy (TARGIT-IORT).  

Professor Vaidya received his first medical degree in 1988, graduating with an MBBS from the University of Bombay. He received his master of surgery from the same institution in 1991, before receiving a DNB in 1993. He then went on to become a fellow of both the Royal College of Surgeons of Glasgow and the Royal College of Surgeons of England, and in 2002 he received his PhD in surgical science from University College London.
Professor Vaidya currently practices privately at King Edward VII’s Hospital Sister Agnes and the London Clinic. In addition to his private practices, Professor Vaidya serves as an oncoplastic breast surgeon at several NHS hospitals across London. He is also a Professor of Surgery and Oncology at University College London.
He splits his time equally between research and clinical work, improving the understanding and treatment of breast cancer. He is extensively published, with over 200 scientific works over a wide range of medical fields, and has contributed to several books on breast cancer, including his own title 'Fast Facts: Breast Cancer´. 
He lectures and gives frequent talks on his specialty, both nationally and internationally, and is regularly invited to speak on the BBC as an expert in his field. He has also been featured in Time magazine, Reader's Digest, and Tomorrow's World, thanks to his pioneering of the concept of targeted intraoperative radiotherapy (TARGIT). This innovative take on radiotherapy enables women to receive radiotherapy at the time of surgery, instead of post-operative courses, enabling lower toxicity, and a safer, more focused treatment.

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