What is it about?
Targeted intraoperative radiotherapy (TARGIT-IORT) delivers radiation directly to the tumour bed during breast-conserving surgery. While its local effects are well established, much less is known about the immediate systemic immune response to this treatment. In this exploratory study, we investigated changes in circulating markers associated with immunogenic cell death, cytotoxic activity and immune signalling before surgery and 24 hours after breast-conserving surgery, with or without TARGIT-IORT.
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Why is it important?
We found that TARGIT-IORT was associated with a distinct early immune signature. The most pronounced change was a marked reduction in circulating HMGB1, accompanied by changes in TRAIL, Fas ligand and perforin-1, as well as a significant increase in M-CSF and reduction in TLR4. These changes were different from those observed following breast-conserving surgery alone. Together, the findings suggest that intraoperative radiation can rapidly alter pathways involved in immunogenic cell death and immune signalling.
Perspectives
These findings provide an early glimpse of how local radiation may interact with systemic immune pathways around the time of surgery. However, this was a small exploratory study with biomarker measurements at a single postoperative time point. Larger randomised studies with longitudinal blood sampling and analysis of tumour tissue will be needed to determine how these early changes evolve and whether they have meaningful implications for anti-tumour immunity or clinical outcomes.
Dr Catherine Worsley
University of Pretoria
Read the Original
This page is a summary of: Modulation of HMGB1, PRF1, TRAIL, and M-CSF after TARGIT-IORT in breast-conserving surgery: defining a unique acute immune landscape, Revista de Oncología, April 2026, Springer Science + Business Media,
DOI: 10.1007/s12094-026-04353-1.
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