Single dose of intraoperative radiotherapy effective for early stage breast cancer patients

In the South East of England, a patient experience study of 18 early stage breast cancer patients who opted for single dose intraoperative radiotherapy (IORT), found positive patient reported outcomes for this alternative to standard daily external beam radiotherapy (EBRT). All participants felt well supported through treatment decision making and patients reported less pain than anticipated. After one month, 89% of patients rated their recovery as good, very good or excellent and 84% returned to full daily activities within four weeks of IORT treatment. The study, which was conducted at the Spire Montefiore Hospital in Hove, East Sussex, included patients from the South East region.

For appropriate early stage breast cancer patients only, the ‘single dose’ radiotherapy option can eliminate the need for EBRT, which is typically administered five days a week, over the course of three to five weeks. IORT is administered at the time of surgery immediately after the tumour is removed. The targeted radiotherapy is delivered to the tumour bed, sparing surrounding healthy tissue in the heart, lungs and ribs from radiation exposure.

“The South East is leading the way in the UK with this ‘single dose’ radiotherapy option for early stage breast cancer patients. The study we conducted among our patients at the Spire Montefiore hospital, demonstrates that women who choose single dose IORT report a positive treatment experience with many returning to normal daily activities very quickly. Clinical trial findings have shown that single dose IORT is an effective alternative for appropriate patients which is well tolerated with few side effects,” Said Dr Charles Zammit, Consultant Breast & Endocrine Surgeon; Honorary Senior Lecturer Brighton and Sussex Medical School, who led the study.

IORT is administered at the point of surgery and can have a positive impact on quality of life, patient satisfaction and convenience. However, despite an initial positive response by NHS England, IORT is not yet routinely available in the UK.

Dr Richard Simcock, Consultant Clinical Oncologist, Sussex Cancer Centre said:

Single dose IORT has an important place in breast cancer care and together with support from a multidisciplinary medical team, patients should have the option to choose the radiotherapy that is right for them. All too often treatment experience is overlooked or not deemed important. Breast cancer patients should be able to make an informed choice on the course of treatment they would prefer, particularly after an often traumatic diagnosis.

Every year, more than 50,000 women in the UK are diagnosed with breast cancer, of whom around four out of five will have early stage disease. More than half of women having surgery for breast cancer have a breast conserving procedure, usually followed by radiotherapy. Radiotherapy is estimated to contribute to 40% of cases where cancer is cured. Breast cancer accounts for approximately 30% of radiotherapy departments’ workload, so IORT could relieve some of the demand. The incidence of breast cancer in Brighton and Hove is similar to the English average of 163.9 per 100,000. One year breast cancer survival in Brighton & Hove is 96.4 percent which is a good indicator of early diagnosis and optimal treatment.

The practical challenges of attending radiotherapy treatment courses are often underestimated, and some patients are deterred by long travel times or high costs associated with attending daily EBRT appointments. The cost of travel to and from appointments affects 69% of people with cancer and costs them, on average, £170 a month.

IORT is a targeted radiotherapy administered at the time of surgery which reduces exposure of surrounding healthy tissue to radiation, provides better cosmetic results compared to EBRT and enables patients to receive treatment promptly. Women with breast cancer are usually ‘fit to treat’ with EBRT 21 days following final surgery. The median number of days from final surgery to radiotherapy was 59 days in England.

The efficacy of IORT was examined in non-inferiority clinical study, which showed that the recurrence of breast cancer in patients who had received IORT was comparable to the recurrence of breast cancer in patients who had received EBRT (2.1% vs. 1.1% at 5-years). The frequency of major side effects and complications was comparable in both groups, although IORT was better tolerated overall than daily radiotherapy.

IORT is not currently available on the NHS. NHS England has decided to wait until more clinical trial data becomes available before making a decision on commissioning. The NICE appraisal committee is currently reviewing IORT following positive draft guidance released in July 2014. Early stage breast cancer patients should have the choice between IORT and EBRT based on the current clinical and real-world evidence available. However, it is important to note that there is a lack of comparative outcome data between IORT and EBRT.