***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND After breast-conserving surgery , 90 % of local recurrences occur within the index quadrant despite the presence of multicentric cancers elsewhere in the breast . Thus , restriction of radiation therapy to the tumour bed during surgery might be adequate for selected patients . We compared targeted intraoperative radiotherapy with the conventional policy of whole breast external beam radiotherapy . METHODS Having safely piloted the new technique of single-dose targeted intraoperative radiotherapy with Intrabeam , we launched the TARGIT-A trial on March 24 , 2000 . In this prospect i ve , r and omised , non-inferiority trial , women aged 45 years or older with invasive ductal breast carcinoma undergoing breast-conserving surgery were enrolled from 28 centres in nine countries . Patients were r and omly assigned in a 1:1 ratio to receive targeted intraoperative radiotherapy or whole breast external beam radiotherapy , with blocks stratified by centre and by timing of delivery of targeted intraoperative radiotherapy . Neither patients nor investigators or their teams were masked to treatment assignment . Postoperative discovery of predefined factors ( eg , lobular carcinoma ) could trigger addition of external beam radiotherapy to targeted intraoperative radiotherapy ( in an expected 15 % of patients ) . The primary outcome was local recurrence in the conserved breast . The predefined non-inferiority margin was an absolute difference of 2.5 % in the primary endpoint . All r and omised patients were included in the intention-to-treat analysis . This trial is registered with Clinical Trials.gov , number NCT00983684 . FINDINGS 1113 patients were r and omly allocated to targeted intraoperative radiotherapy  and 1119 were allocated to  external beam radiotherapy .  Of 996 patients who received the allocated treatment in the targeted intraoperative radiotherapy group , 854 ( 86 % ) received targeted intraoperative radiotherapy only and 142 ( 14 % ) received targeted intraoperative radiotherapy plus external beam radiotherapy . 1025 ( 92 % ) patients in the external beam radiotherapy group received the allocated treatment . At 4 years , there were six local recurrences in the intraoperative radiotherapy group and five in the external beam radiotherapy group . The Kaplan-Meier estimate of local recurrence in the conserved breast at 4 years was 1.20 % ( 95 % CI 0.53 - 2.71 ) in the targeted intraoperative radiotherapy and 0.95 % ( 0.39 - 2.31 ) in the external beam radiotherapy group ( difference between groups 0.25 % , -1.04 to 1.54 ; p=0.41 ) . The frequency of any complications and major toxicity was similar in the two groups ( for major toxicity , targeted intraoperative radiotherapy , 37 [ 3.3 % ] of 1113 vs external beam radiotherapy , 44 [ 3.9 % ] of 1119 ; p=0.44 ) . Radiotherapy toxicity ( Radiation Therapy Oncology Group grade 3 ) was lower in the targeted intraoperative radiotherapy group ( six patients [ 0.5 % ] ) than in the external beam radiotherapy group ( 23 patients [ 2.1 % ] ; p=0.002 ) . INTERPRETATION For selected patients with early breast cancer , a single dose of radiotherapy delivered at the time of surgery by use of targeted intraoperative radiotherapy should be considered as an alternative to external beam radiotherapy delivered over several weeks . FUNDING University College London Hospitals (UCLH)/UCL Comprehensive Biomedical Research Centre , UCLH Charities , National Institute for Health Research Health Technology Assessment programme , Ninewells Cancer Campaign , National Health and Medical Research Council , and German Federal Ministry of Education and Research ( BMBF ) Background Since the results from the r and omized TARGIT A trial were published , intraoperative radiotherapy ( IORT ) is used more often . IORT can be provided as accelerated partial breast irradiation ( APBI ) or as a boost . The definition of suitable patients for IORT as APBI differs between different national societies ( e.g. ESTRO and ASTRO ) and different inclusion criteria of trials and so does the eligibility of patients . This analysis identifies eligible patients for  IORT according to available consensus statements and inclusion criteria of the ongoing TARGIT trials . Methods Between 01/03 – 12/09 , 1505 breast cancer cases were treated at the breast cancer center at the University Medical Center Mannheim . Complete data sets for age , stage ( T , N , and M ) , histology and hormone receptor status were available in 1108 cases . Parameters to identify eligible patients are as follows : ESTRO : > 50 years , invasive ductal carcinoma/other favorable histology ( IDC ) , T1 - 2 ( ≤3 cm ) , N0 , any hormone receptor status , M0 ; ASTRO : ≥60 years , IDC , T1 , N0 , positive estrogen hormone receptor status , M0 ; TARGIT E “ elderly ” , risk adapted radiotherapy with IORT followed by external beam radiotherapy in case of risk factors in final histopathology , phase II : ≥70 years , IDC , T1 , N0 , any hormone receptor status , M0 ; TARGIT C “ consolidation ” , risk adapted radiotherapy , phase IV : ≥50 years , IDC , T1 , N0 , positive hormone receptor status , M0 ; TARGIT BQR “ boost quality registry ” : every age , every histology , T1 - 2 ( max . 3.5 cm ) , any hormone receptor status , N0/+ , M0/+ . Results Out of the 1108 cases , 379 cases ( 34.2 % ) were suitable for IORT as APBI regarding the ESTRO and 175 ( 15.8 % ) regarding the ASTRO consensus statements . 82 ( 7.4 % ) patients were eligible for the TARGIT E trial , 258 ( 23.3 % ) for the TARGIT C trial and 671 ( 60.6 % ) for the TARGIT BQR registry . According to the consensus statements of ASTRO ( 45.1 % ) and ESTRO ( 41.4 % ) about half of the eligible patients were treated with IORT as APBI . From the eligible patients fulfilling the criteria for IORT boost ( 35 % ) about one third was eventually treated . Conclusions Patient selection for IORT should be restrictive . For IORT as APBI the TARGIT trials are even more restrictive including patients than the ESTRO and ASTRO consensus statements BACKGROUND A r and omised trial was conducted comparing wide lumpectomy and breast irradiation with modified radical mastectomy . As the follow-up was long ( mean duration 22 years ) , we analysed the variation in the effect of treatment over time . PATIENTS AND METHODS The trial included 179 patients with a breast cancer measuring < /=2 cm at macroscopic examination . Eighty-eight patients had breast-conserving surgery and radiotherapy , and 91 underwent mastectomy .  All patients had axillary dissection .  The analyses were based on Cox models with time-dependent treatment effects . RESULTS The effect of treatment on death or metastasis did not vary with time . The risk of local recurrence was lower during the first 5 years for the breast-conserving surgery group as compared with the mastectomy group , but higher after 5 years ( P = 10(-4 ) for a different treatment effect over time ) . Similar results were found in a data base including 1847 patients with small breast tumours at diagnosis . In this analysis , late breast recurrences were also more frequent in the breast-conserving surgery group and this treatment effect was greater among younger patients ( < /=40 years at the time of diagnosis ) . CONCLUSIONS Late breast recurrences were more frequently observed in younger patients treated with breast-conserving treatment compared with those su bmi tted to mastectomy . These results require confirmation in other r and omised studies so that younger patients with early breast cancer can receive adequate counselling and so that a more stringent long-term follow-up policy can be adopted when breast-conserving treatment is planned PURPOSE Mastectomy versus excisional biopsy ( lumpectomy ) plus radiation for the treatment of stage I and II breast cancer was compared in a prospect i ve r and omized study . PATIENTS AND METHODS From 1979 to 1987 , 247 women were r and omized and 237 were treated on this study . All patients received a full axillary dissection and all node-positive patients received adjuvant chemotherapy with cyclophosphamide and doxorubicin . Radiation consisted of external-beam therapy to the whole breast with or without supraclavicular nodal irradiation followed by a boost to the tumor bed . RESULTS The minimum time on the study was 18 months and the median time on the study was 68 months . No differences in overall survival or disease-free survival were observed . Actuarial estimates at 5 years showed that 85 % of mastectomy-treated patients were alive compared with 89 % of the lumpectomy/radiation patients ( P2 = .49 ; 95 % two-sided confidence interval [ CI ] about this difference , 0 % to 9 % favoring lumpectomy plus radiation ) . The probability of failure in the irradiated breast was 12 % by 5 years and 20 % by 8 years according to actuarial estimates . Of 15 local breast failures , 14 were treated with and 12 were controlled by mastectomy ; the ultimate local-regional control was similar in both arms of the trial . CONCLUSION These data add further weight to the conclusion that breast conservation using lumpectomy and breast irradiation is equivalent to mastectomy in terms of survival and ultimate local control for stage I and II breast cancer patients BACKGROUND The TARGIT-A trial compared risk-adapted radiotherapy using single-dose targeted intraoperative radiotherapy ( TARGIT ) versus fractionated external beam radiotherapy ( EBRT ) for breast cancer . We report 5-year results for local recurrence and the first analysis of overall survival . METHODS TARGIT-A was a r and omised , non-inferiority trial . Women aged 45 years and older with invasive ductal carcinoma were enrolled and r and omly assigned in a 1:1 ratio to receive TARGIT or whole-breast EBRT , with blocks stratified by centre and by timing of delivery of targeted intraoperative radiotherapy : r and omisation occurred either before lumpectomy ( prepathology stratum , TARGIT concurrent with lumpectomy ) or after lumpectomy ( postpathology stratum , TARGIT given subsequently by reopening the wound ) . Patients in the TARGIT group received supplemental EBRT ( excluding a boost ) if unforeseen adverse features were detected on final pathology , thus radiotherapy was risk-adapted . The primary outcome was absolute difference in local recurrence in the conserved breast , with a prespecified non-inferiority margin of 2·5 % at 5 years ; prespecified analyses included outcomes as per timing of r and omisation in relation to lumpectomy . Secondary outcomes included complications and mortality . This study is registered with Clinical Trials.gov , number NCT00983684 . FINDINGS Patients were enrolled at 33 centres in 11 countries , between March 24 , 2000 , and June 25 , 2012 . 1721 patients were r and omised to TARGIT and 1730 to EBRT .  Supplemental EBRT after TARGIT was necessary in 15·2 % [ 239 of 1571 ] of patients who received TARGIT ( 21·6 % prepathology , 3·6 % postpathology ) . 3451 patients had a median follow-up of 2 years and 5 months ( IQR 12 - 52 months ) , 2020 of 4 years , and 1222 of 5 years . The 5-year risk for local recurrence in the conserved breast was 3·3 % ( 95 % CI 2·1 - 5·1 ) for TARGIT versus 1·3 % ( 0·7 - 2·5 ) for EBRT ( p=0·042 ) . TARGIT concurrently with lumpectomy ( prepathology , n=2298 ) had much the same results as EBRT : 2·1 % ( 1·1 - 4·2 ) versus 1·1 % ( 0·5 - 2·5 ; p=0·31 ) . With delayed TARGIT ( postpathology , n=1153 ) the between-group difference was larger than 2·5 % ( TARGIT 5·4 % [ 3·0 - 9·7 ] vs EBRT 1·7 % [ 0·6 - 4·9 ] ; p=0·069 ) . Overall , breast cancer mortality was much the same between groups ( 2·6 % [ 1·5 - 4·3 ] for TARGIT vs 1·9 % [ 1·1 - 3·2 ] for EBRT ; p=0·56 ) but there were significantly fewer non-breast-cancer deaths with TARGIT ( 1·4 % [ 0·8 - 2·5 ] vs 3·5 % [ 2·3 - 5·2 ] ; p=0·0086 ) , attributable to fewer deaths from cardiovascular causes and other cancers . Overall mortality was 3·9 % ( 2·7 - 5·8 ) for TARGIT versus 5·3 % ( 3 
    Output:
    
IORT had a significantly higher risk of ipsilateral breast tumor recurrence than whole-breast  EBRT .
Overall mortality did not differ significantly .