July 2014 - The National Institute for Health and Care Excellence (NICE) has published draft guidance on the use of intrabeam radiotherapy for patients with early stage cancer. The technique, called intra-operative radiotherapy (IORT) involves the delivery of a single dose at the same time as surgery to remove a tumour. NICE said it would improve patients' quality of life, but that there are some doubts over about the effectiveness of IORT compared with conventional radiotherapy and patients should be made aware in advance of the pros and cons of both treatments.
While IORT will not be suitable for all patients with breast cancer, the use of Intrabeam is an interesting development and could be good news for some with early stage disease. However, the use of Intrabeam (radiotherapy during surgery) is just one option for the treatment of early stage breast cancer. Research is in its early days, and its use will be considered by NICE’s appraisal committee at the end of August 2014.
The NICE committee concluded that the trial should be interpreted with caution as the length of follow up was less than five years for the full trial population. The committee also considered the clinical and cost effectiveness evidence for Intrabeam remained uncertain.
Cancer Partners UK will be particularly be interested to see the results the initial five year trial when they become available, and of any trials comparing Intrabeam to the delivery of IMRT/IGRT.
- This is not NICE's final guidance on this technology - the closing date for comments is 15th August and there will be a second appraisal committee on 27th August.
- Intrabeam (delivery of one dose of RT during surgery) is recommended as one option for adjuvant treatment of early breast cancer during breast conserving surgical removal of the tumour.
- Early breast cancer is confined to the breast and ipsilateral axillary lymph nodes usually classified as stage I or II.
- A trial was conducted across 33 centres in 11 countries (including the UK) comparing Intrabeam with EBRT.
- The technology, clinical effectiveness, cost effectiveness and additional factors such as psychological burden of disease were reviewed.
- It has been estimated that 16% of people diagnosed with breast cancer could be eligible to receive this treatment if it becomes routinely available.
- A committee of experts reviewed the trial data and concluded that the results of TARGIT-A trial should be interpreted with caution because the length of follow up was less than five years for the full trial population.
- The committee concluded that some doubt remained about the general ability of the trial data to NHS clinical practice. Furthermore, the committee considered the clinical and cost effectiveness evidence for Intrabeam remained uncertain.
- Many of the aspects compared within the initial trial data are already actively being addressed by treatment modalities at Cancer Partners UK including patients suffering with early stage breast cancer being treated using IMRT, daily IGRT and – where appropriate – deep inspiration breath-hold (DIBH)