Convenience Counts: IORT for Breast Cancer
For women with early stage breast cancer, a lumpectomy followed by radiation therapy has been shown to be an effective treatment. For some women, however, undergoing radiation five days a week for up to six weeks is fatiguing and difficult to negotiate with work and family obligations.
Now, physicians at the Inova Fair Oaks Hospital Breast Cancer Program are offering a new, study-proven technique called intraoperative radiation therapy (IORT) that allows women to receive radiotherapy at the time of surgery. The radiation is delivered in a single dose at the tumor site where the cancer was removed. While standard radiation therapy uses external radiation to treat the whole breast, IORT delivers a concentrated dose of radiation that targets a specific area while sparing the rest of the breast.
IORT and quality of life
“Intraoperative radiation therapy provides an answer to some of the difficulties that people face when they need radiotherapy,” says Hernan Vargas, MD. “Traditionally, radiotherapy is given in small doses on a daily basis for several weeks. That can significantly affect the patient’s quality of life after surgery.”
The ideal candidate for IORT, says Dr. Vargas, is a woman over 50 who has a small tumor, has been diagnosed with estrogen receptor positive breast cancer — which he says is less likely to recur — and has no evidence of cancer cells in the lymph nodes.
Currently, the Inova Breast Cancer Program is offering IORT through a clinical trial, since it is still being studied for long-term effectiveness. It is an option offered to select patients, says Stella Hetelekidis, MD, radiation oncologist at Inova Fair Oaks, and the principal investigator for the study at Inova.
“With a short follow-up time of a few years, it appears that in selected patients, treatment with IORT may be as effective as external beam radiation,” says Dr. Hetelekidis.
She points out that because IORT only treats a very limited amount of breast tissue around the surgical area, if there is a cancer cell beyond this area, it will not be effectively treated. “This is why we are doing this trial. We want to make sure that the cancer-free rates at 10 years are similar to the great rates we see with whole-breast radiation therapy,” says Dr. Hetelekidis.
“IORT is definitely a promising option for select patients with early-stage breast cancer,” adds Ashish Chawla, MD, Medical Director of Radiation Oncology at Inova Fair Oaks. “It offers the potential of finishing radiation treatment at the same time as surgery. Early evidence suggests that for select patients, IORT may be comparable to whole breast radiation.”
This Northern Virginia resident found IORT can be more patient-friendly
For Cathy Mechlin, choosing IORT over four to six weeks of standard radiation therapy made sense. Diagnosed with stage 1 breast cancer last February, the busy associate pastor of a local church needed a treatment option that would allow her to resume her pastoral duties as soon as possible. “Drs. Vargas and Hetelekidis gave me options for what needed to be done after the lumpectomy. When I heard about intraoperative radiation therapy, I said I’m going to opt for that because it’s done all at one time and it’s done while you’re asleep. It was more convenient,” recalls Cathy.
Following the surgery and IORT, Cathy healed quickly and didn’t need any pain medication. Within a week she was back to work at her church. And her findings were such that additional radiation therapy was not needed. “I had a really good outcome, my healing process, everything,” says Cathy, now cancer-free. “I highly recommend it to women for whom it is appropriate.”
Lower radiation exposure
Thanks to IORT, doctors are able to shield surrounding healthy tissue and organs such as the skin, lungs and heart during the procedure. “We take steps to protect the surrounding tissue. We do this by visualizing the tissue during surgery, and we also use ultrasound to ensure there is enough distance between the applicator and other organs or tissues we want to protect,” says Dr. Vargas.
He and Dr. Hetelekidis are excited that their team is able to offer women a new option for preventing breast cancer recurrence. “IORT is part of the arsenal that we have for treating breast cancer,” Dr. Vargas says. “It is not the only tool that we have, but it is a tool that is helpful in a number of cases. IORT makes radiation therapy easier for the patient and allows us to base treatment on the patient’s goals and expectations and select the right treatment for them.”
During intraoperative radiation therapy (IORT), the breast cancer surgeon places a sphere-shaped device inside the surgical cavity where the tumor was removed. The radiation oncologist then delivers the treatment over approximately 20 minutes around the applicator.
“After taking steps to protect the skin from the radiation, then we deliver the dose,” says Dr. Vargas.
While the tumor bed area receives a single very high dose of radiation, the surrounding tissues are exposed to less radiation.
Call a Breast Cancer Navigator
If you have questions about next steps after a breast cancer diagnosis, feel free to call an oncology nurse navigator at the Inova Fair Oaks Hospital Breast Cancer Program at 703-391-4673.
Breast cancer clinical trials
To learn more about breast cancer clinical trials through the Inova Breast Cancer Program, call 571-472-4724.
FREE Ask the Expert lecture: “Oncology Nutrition”
Monday, Oct. 23, 2017 @ 6 p.m.
Join Registered Dietitian Sara Negron, RD, for this free discussion of nutrition and cancer. Along with nutrition while in cancer treatment, you will also learn about eating for prevention and health in survivorship.
Location: Inova Fair Oaks Hospital, Building 3580, Auditorium