New Technology Shortens Breast Cancer Treatment Time
Sandy Jones of Hinesville had just started a brand new job when she discovered a lump in her breast. The 44-year-old had already had a mammogram just four months earlier, and everything looked fine. She was certain the lump in her right breast was nothing more than a cyst. Her gynecologist agreed that it was probably nothing, but requested another mammogram, just to be safe.
Jones was scheduled to travel for work on the day of her mammogram. She was anxious to get the procedure completed and get on the road.
“I thought it would take 20 minutes and they’d be done. But I saw several people looking at my mammogram and discussing it. Then they told me I should have a biopsy,” said Jones.
The biopsy to remove a sample of tissue was performed on a Wednesday. On Thursday, Jones learned that she had breast cancer. On Friday, she found herself sitting in the office of Ray Rudolph, M.D., MPH, a breast surgeon at the Center for Breast Care. Jones said it all happened so fast, she barely had time to think.
Rudolph told Jones that she was a candidate for a new procedure called INTRABEAM intraoperative radiation therapy (IORT). Memorial University Medical Center was the first hospital in the state of Georgia to offer INTRABEAM IORT, and the technology had only been in Savannah for about six months.
“We’re always looking for better ways to treat women with breast cancer. We want to find less invasive treatments that are just as effective,” said Rudolph. He and his colleague, radiation oncologist Aaron Pederson, M.D., were instrumental in bringing the technology to the Curtis and Elizabeth Anderson Cancer Institute at Memorial University Medical Center.
With IORT, cancer-killing radiation is delivered in the operating room, at the time of the lumpectomy. After the cancer tumor is removed by the breast surgeon, a radiation oncologist places a small applicator -- 3 to 5 centimeters in diameter -- into the tumor bed. Depending on the tumor size, the applicator is left in place for 13 to 43 minutes and delivers a dose of radiation directly into the tumor cavity.
“The advantage of IORT is you can put the radiation exactly where you just took out the tumor. With breast cancer, most recurrence occurs within 1 centimeter of the original tumor. With IORT, the radiation is given right where you need it,” said Pederson.
Jones learned that traditional treatment for her cancer would involve a lumpectomy followed by six-and-a-half weeks of daily whole breast radiation. But with IORT, she could reduce that to just three weeks of daily radiation. The IORT would serve as a “boost” and cut her radiation treatment time in half. For some women who meet specific criteria, IORT can eliminate the need for any additional radiation after surgery. Whether IORT can serve as a boost or as the entire treatment depends on several factors, including the woman’s age, surgical margins, and tumor characteristics. If a woman needs chemotherapy, they can receive it after IORT.
“I tell my patients going into IORT, that you either win or you win big,” said Rudolph.
Jones had surgery and IORT on March 25, 2013. Two weeks later, she was at the Susan G. Komen Race for the Cure in downtown Savannah.
“IORT was absolutely the right choice for me. At the race, nobody could even tell I’d had surgery,” said Jones. In fact, some Race for the Cure participants had undergone surgery and IORT just two days prior, and they were able to attend the event.
Jones especially appreciated IORT when she began her three weeks of daily whole-breast radiation treatments. She had to drive back and forth from her home in Hinesville to Savannah for treatment. Whole breast radiation can cause side effects such as fatigue and skin damage. But these effects are reduced when the treatment time is shortened. Intraoperative radiation therapy helps many women avoid radiation side effects altogether.
“We’re seeing that IORT has a better cosmetic outcome than traditional radiation. There is no dimpling, no swelling, none of the skin changes you might see with six weeks of whole breast radiation,” said Pederson.
Intraoperative radiation therapy is new to Georgia, but it has been studied extensively around the world for the last decade. Researchers have found that the rate of breast cancer recurrence with IORT is 2 percent higher than with whole breast radiation. However, overall long-term survival is improved with IORT. Scientists believe this is because IORT does not cause the heart or lung damage that may occur in traditional radiation.
Rudolph and Pederson predict that IORT will eventually become the preferred standard of care for early-stage breast cancers.
“This treatment creates less disruption and fewer side effects for patients. And it’s less expensive than other types of radiation. With IORT, we can provide an equally effective treatment for one-tenth of the cost and in one-thirtieth of the time” said Pederson.
Just three months after being diagnosed with breast cancer, Sandy Jones was back at work full time and maintaining a heavy travel schedule. When asked how she feels about receiving IORT, her response is simple: “thankful.”