Coombs, N., Coombs, J., Vaidya, U., Singer, J., Bulsara, M., Tobias, J., Wenz, F., Joseph, D., Brown, D., Rainsbury, R., Davidson, T., Adamson, D., Massarut, S., Morgan, D., Potyka, I., Corica, T., Falzon, M., Williams, N., Baum, M., & Vaidya, J. (2016). Environmental and social benefits of the targeted intraoperative radiotherapy for breast cancer: Data from UK TARGIT-A trial centres and two UK NHS hospitals offering TARGIT IORT. BMJ Open, 6 (5).
Objective: To quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks’ course of external beam whole breast radiotherapy (EBRT) treatment.
Setting: (1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT.
Participants: 485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres.
Outcome measures: The shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy.
Methods: Distances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the nonparametric Wilcoxon rank-sum (Mann-Whitney) test.
Results: TARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient).
Conclusions: The use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in the UK.
Trial registration number: ISRCTN34086741; Post results.
breast cancer, targeted intraoperative radiotherapy (TARGIT), external beam whole breast radiotherapy (EBRT), TARGIT-A randomized clinical trial, CO2 emissions