Treating Breast Cancer with IORT
Intra-Operative Radiation Therapy
By Robin O'Connor
Receiving a diagnosis of breast cancer is never easy, but knowing there is a new therapy called intra-operative radiation therapy (IORT) that may reduce cancer recurrence may take away some anxiety.
Today, many women diagnosed with breast cancer undergo lumpectomy, removing only the tumor and a margin of healthy tissue surrounding the tumor. Although mastectomy is still required in a small number of cases, the necessity has diminished. IORT has become an alternative treatment for some women with breast cancer, depending on the size of the tumor. As compared to traditional treatments, some benefits include quicker radiation available at the time of lumpectomy, less radiation exposure to tissue around the tumor, and reducing the risk of cancer returning.
Because Donna Lee Fivis’ breast cancer was caught early when her tumor was still small enough to meet the medical criteria, she was offered IORT. “I want to make sure other women know about this procedure and how important it is to catch a breast lump early. Women need to know it’s available,” states Donna. She received IORT in the operating room and has not needed chemotherapy or additional radiation therapy.
Even though surgeons make every effort to remove all cancerous tissue at the time of surgery, microscopic cancer cells are difficult to detect. “Tumors tend to happen again in the same area. IORT kills microscopic cancer cells in the tumor bed and provides the maximum defense against a recurrence,” explains Amara Malik, M.D., Sutter Pacific Medical Foundation breast surgeon based at CPMC.
For some patients like Donna, IORT may be the only radiation treatment they need. For others, IORT can kickstart their radiation therapy, reducing the length of treatments, typically given daily over a four- to five-week period. With IORT, Donna’s radiation dose exposure was only 50 percent of what she would have received had she been treated with a full course of radiation therapy.
In the operating room, the IORT applicator is placed into the tumor bed (the space where the tumor was removed). “I work closely with the radiation oncologist to select the IORT probe so that it is the same size as the tumor bed. Depending on the tumor bed size, the probe remains in place from 20 to 50 minutes, adding only minutes to the operating room time. And no matter the size of the probe, patients receive the same radiation dose,” explains Malik. The entire dose of radiation is delivered in 20 to 50 minutes, then the breast surgeon removes the probe and closes the incision.
Traditional Radiation Therapy vs. IORT
“IORT is easier on the patient than traditional radiation therapy since we can actually see the tumor bed at the time of treatment,” explains John Lee, M.D., radiation oncologist at CPMC. “The radiation is localized to the tumor cavity, so the lungs, ribs and heart are protected.” Because the treatment is targeted within the tumor bed, IORT spares healthy surrounding tissues.
Future IORT Treatment Sites
CPMC’s first IORT breast cancer case was done in early September 2011. Although IORT is currently used for breast cancer, the potential for treating other cancer types is on the horizon. “In the next year, we are considering using IORT to treat other high-risk tumors, such as head and neck, colorectal, and lung cancers to reduce cancer reoccurrence,” explains Lee.
“It’s so quick, patients love it,” says Malik. There are fewer side effects, less pain, fewer skin problems, and it’s very convenient. Because the surgery and the radiation therapy can be done at the same time, patients like it. Donna’s anesthesiologist helped her relax with guided imagery, and her surgical nurse held her hand and helped her breathe before she went into the operating room. “The care I was given, the kindness, the dignity, it was overwhelming. The surgical team provided me with excellent care,” states Donna. “I feel so blessed; my husband feels they saved my life, but I know they saved my life.”
Who Qualifies for IORT Treatment
- Lumpectomy procedure
- Over 45 years of age
- Early stage cancer
- Estrogen receptor positive
- Tumor 2 centimeters insize or smaller