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SHTAC publishes new report on the INTRABEAM® Photon Radiotherapy System for the adjuvant treatment of early breast cancer

Published: 21 September 2015
Breast cancer is the most common cancer in women in England

A systematic review and economic evaluation of intraoperative radiation therapy delivered by the INTRABEAM Photon Radiotherapy System is now available.

The report, “The INTRABEAM® Photon Radiotherapy System for the adjuvant treatment of early breast cancer: a systematic review and economic evaluation” is freely available from the NIHR Journals Library.

Breast cancer is the most common cancer in women in England. Although there is no single definition of early breast cancer, a common definition is cancer that is confined to the breast and draining nodes for which treatment could be curative. Initial treatment for early breast cancer is usually either wide local excision (removal) of the tumour [breast-conserving surgery (BCS)] or mastectomy. After BCS, whole-breast external beam radiotherapy (WB-EBRT) is commonly used to reduce the risk of breast cancer returning in the affected breast (local recurrence). A newer potential alternative to post-operative WB-EBRT is intraoperative radiation therapy delivered by the INTRABEAM® Photon Radiotherapy System to the tissue adjacent to the resection cavity at the time of surgery. Providing INTRABEAM is as effective and safe as the current WB-EBRT approach, the benefit to patients is that the standard 3-week course of WB-EBRT would be avoided for the majority of patients eligible for INTRABEAM treatment.

The systematic review identified one randomised controlled trial (RCT), the TARGeted Intraoperative radio Therapy Alone (TARGIT-A) trial which aimed to determine whether the outcome of INTRABEAM treatment was no worse than EBRT. The review found that local recurrence of breast cancer was slightly higher following INTRABEAM than WB-EBRT, but the difference did not exceed the 2.5% difference margin permitted, providing INTRABEAM was given at the same time as BCS. Overall patient survival was similar with both treatments. Some complications were more common in patients who had received INTRABEAM treatment whilst were more common in patients receiving WB -EBRT. Cost-effectiveness analysis indicates that INTRABEAM is less expensive but also less effective than WB-EBRT because it is associated with lower total costs but fewer total quality-adjusted life-years gained. However, because disease progression inputs for the model are largely drawn from the single available RCT the model is subject to uncertainty. When alternative values for some model inputs are used, the model results are reversed and INTRABEAM could be considered cost-effective. The review recommends longer-term follow-up data from the TARGIT-A trial and analysis of registry data because results are currently based on a small number of local recurrence events and economic modelling results are uncertain.

The National Institute for Health and Care Excellence (NICE) is expected to publish guidance on the INTRABEAM radiotherapy system for treating early breast cancer in November 2015.

For more information on SHTAC's research into cancer please visit our Research page.

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