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Radiation during breast cancer surgery an option for some patients

October 30, 2015 | Patricia Harriman
doctor with patient after iort

UCI Health surgical oncologist Dr. Karen Lane believes that breast cancer treatment should be tailored to fit each patient’s needs.

“Not all breast cancer is alike, each patient is unique, and some women may have options when it comes to treatment,” she said. 

“One of the latest advances in treatment is a single dose of radiation administered at the time of lumpectomy.”

Potential benefits

Called intraoperative radiation therapy (IORT), some women with early stage breast cancer may choose to receive a single, concentrated dose of radiation in the tumor cavity while in the operating room, rather than undergoing traditional radiation therapy. Traditional whole breast radiotherapy can require as many as five treatments a week for up to eight weeks, and may also expose healthy tissue, such as heart and lungs, to radiation.

As convenient and appealing as a one-time treatment versus 40 daily treatments may be, Lane says that only those patients who meet strict criteria based on age, tumor size and tumor type should be offered the option.

“Basically, it is for post-menopausal women with early stage breast cancer,” she says. “I have used IORT 30 times and all of my patients are doing great, with no recurrences or serious complications.”

Not for every woman

Though the technology has been used in U.S. hospitals for more than 10 years, the first IORT devices were large and unwieldy. The current generation of devices is smaller, easier to use and more widely available, but there has been some controversy over the treatment’s effectiveness.

The TARGIT-A randomized clinical trial of the Zeiss Intrabeam® device found that breast cancer recurred after five years in 3.3 percent of the women who had IORT compared with 1.3 percent of women who underwent traditional external beam whole breast therapy.

“At the time of the trial, some doctors administered IORT during lumpectomy surgery, while others performed a second procedure and later re-opened their incision to deliver the dose,” Lane says. “Performing post-op IORT radiation rather than during lumpectomy resulted in unfavorable recurrence rates. As a result, that procedure is no longer practiced.”

When the post-operative results are eliminated, the recurrence rates for IORT and traditional radiotherapy are not statistically significant, she says.

“Women who meet the standards can now benefit from minimally invasive breast surgery and minimally invasive radiation treatment,” Lane says.

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