Practicalities of Targeted Radiotherapy in Non-Radiotherapy Departments for Breast Tumor Treatment

Background: The National Institute for Health and Care Excellence (NICE) has several times reviewed the use of IORT with a view to approves the use of Targit intrabeam radiotherapy as a treatment option for people with early breast cancer. There have been some reservations from the Royal Collage of Radiologists (RCR) and concern from certain parties, even though NICE has agreed that intra-operative radiotherapy (IORT) would improve patients' quality of life. IORT offers accelerated partial breast irradiation (APBI) and intraoperative boosting for patients affected by breast cancer. Importantly it may reduce the risk of major coronary events (MCE) from reduced radiotherapy treatment as Darby SC, et al. has shown that there is a 7.4% increase in MCE per Gray (Gy). There are numerous ‘hidden' advantages such as travel time to and from the treatment centre, reduced transport costs as well as time saving to the individual and their carer's. These advantages along with the reduced shielding requirements compared to conventional radiotherapy and the growth in the private sector, mean we can see that the implementation of IORT could become a growth industry. Certainly there has been increasing interest and demand from patients for this kind of treatment. In this paper we aim to discuss and provide solutions to setting up a Targit IORT (Zeiss) system in a non-radiotherapy department. IORT is routinely used to treat breast cancer in the USA (North and South America), the Middle East, Germany and other European countries and was recently approved for use in Australia in 2015. System: The Zeiss manufactured system consists of a miniature, high dose rate, and low energy 50kV x-ray source (XRS). 0.05mA electrons are accelerated and delivered with a 10cm long 3.2mm diameter probe with an Au target inside various size spherical applicators to match the tumour size. The applicator is placed in the tumour bed and the effective energy delivered is approximately 20keV or less with the dose falling off at (1/r3).