By Jane Claspy Nesmith, for The Gazette
Iowa women who receive a diagnosis of early-stage breast cancer may be able to cut in half — or sometimes even eliminate — the need for outpatient radiation therapy following surgery thanks to a relatively new treatment called inter-operative radiation therapy.
Typically, in early-stage breast cancer, radiation is given after surgery for six weeks. During that time, the woman must travel to a hospital or other radiation provider five days a week to receive radiation therapy.
Although radiation is standard treatment and can be very effective, it’s not always easy for the patient. Radiation can cause unwanted side effects, such as fatigue and skin rashes. Sometimes, patients are unable to follow through with this radiation therapy because of time, distance or finances.
With this therapy, radiation therapy is delivered when the woman is in surgery for a lumpectomy, the removal of a tumor or cancerous area from her breast. First, the surgeon removes the tumor, leaving a cavity where the tumor was located. Then the radiation oncologist shields the healthy tissue and vital organs from the radiation. Once that is done, an applicator tip is fitted into the cavity. Radiation is delivered through this applicator directly into the tumor bed. When the applicator is removed, the surgeon closes the incision.
“The main advantage of this treatment is patient convenience,” says Dr. Sonia Sugg, medical director of the Breast Health Center at University of Iowa Hospitals and Clinics in Iowa City. “This is especially good for women who live far away from a radiation center. Because Iowa is a rural state, this technique is very beneficial here.”
It also is less expensive: “We’ve been able to demonstrate a 17 percent decrease in cost,” says Dr. Robert Brimmer, general surgeon at Physicians’ Clinic of Iowa in Cedar Rapids.
Two types of intra-operative radiation therapy are available in Eastern Iowa. At UIHC, the procedure is called IORT, and radiation is administered for 20 to 45 minutes during the lumpectomy surgery. This shortens the number of weeks radiation must be given after surgery and sometimes even alleviates the need for outpatient radiation therapy entirely.
At UnityPoint Clinic — St. Luke’s Hospital in Cedar Rapids, a slightly different therapy, called intra-operative electron radiation therapy, or IOERT, is used. This type of radiation can be more powerful than standard IORT, and is adjustable. It takes less time to deliver during surgery — just one to two minutes. Outpatient radiation is required after surgery, typically lasting three weeks.
Doctors carefully select patients for this therapy. In general, it has been shown to be best for women who have early-stage cancer with small tumors and little to no lymph node involvement. These are women for whom six weeks of radiation is normally prescribed.
Also, according to Brimmer, women who do not have dense breast tissue tend to have the best results from radiation in general, so they are considered good candidates for the new therapies.
Although these are relatively new treatments, they use well-established practices that are known to be effective against breast cancer.
“These are standard forms of treatment used in novel ways to shorten the time of treatment, and protect the skin and vital organs,” Brimmer says.
This story originally appeared in the Oct. 6, 2013 Surviving Breast Cancer special section.