When the Diagnosis is Breast Cancer, You Have Options
Upon receiving a diagnosis of breast cancer, too many women jump to the conclusion that they will lose one or both breasts.
Julie Reiland, MD, Avera Medical Group breast surgeon, would tell them differently. “There are advanced surgical and treatment options that conserve the breast and even improve the appearance of the breast. Through technology known as IORT, many women can get radiation treatment to prevent recurrence of cancer at the same time as surgery,” she said.
For the past six years, Avera has been part of groundbreaking clinical study testing electron-based intraoperative radiation therapy (IORT) with lumpectomy.
Reiland says the treatment of breast cancer may involve multi-faceted treatment: surgery to cut the cancer out of the breast, radiation to kill any cells that may be left behind, and chemotherapy to go throughout the body to prevent any cancer cells from going to other organs. “Surgery with IORT takes care of the local control of breast cancer in one day, and then we also may add chemotherapy – often pills – to protect a woman from the spread of cancer cells to other organs.”
Finding Proper IORT Candidates
Women age 60 and older have been able to get their complete radiation treatment with a single dose of electron-based IORT at the time of surgery. Soon, that age will be lowered to 50. For younger women, IORT cuts the course of radiation therapy after surgery in half, from six to three weeks. “For many women, it can be a one-and-done treatment as far as their surgery and radiation are concerned,” Reiland said.
For women whose type and stage of cancer qualify for this treatment, data show that lumpectomy followed by IORT is just as safe as mastectomy. And recently, the American Society for Radiation Oncology (ASTRO) recommended IORT as a standard treatment, so it can be used outside the realm of a clinical trial.
Reiland cautioned that not all IORT is the same. There’s an important distinction between electron-based IORT and low-voltage (LV) proton-based IORT.
Felix Sedlmayer, MD, of Paracelsus Medical University in Salzburg, Austria, was a pioneer in using IORT for breast cancer and initiated the clinical trial in which Avera Cancer Institute in Sioux Falls was the first U.S. site to participate.
“In the late 1990s, IORT was focusing on pancreatic, gastric and rectal cancer and sarcoma. We believed it could be a very elegant method to do an ultra-precise boost of radiation at the time of lumpectomy for breast cancer patients,” Sedlmayer said.
The difference in forms of IORT is a matter of physics and the depth that LV photons or electrons penetrate tissue, Sedlmayer explained. LV protons penetrate only about a half centimeter, while electrons penetrate up to 3 cm within any direction of the tumor site.
“At Avera, we’re using electron-based IORT – the best form of energy for radiation oncology,” Reiland said. “If you’re interested in IORT, make sure to ask what form of energy is being delivered.”
Among the First Patients
Sherri Baseley of Sioux Falls was among the first patients treated through the IORT trial. “When I first saw a surgeon, the recommendation was a lot more drastic than what I was interested in. It seemed more gloom and doom than I wanted to accept.”
When you’re diagnosed with breast cancer it is not a death sentence, Baseley said. “It’s a medical condition and you’re wise to look into every option because the technology is constantly changing.”
Baseley also realized she had time to make an informed decision. “The tumor had been growing for some time, even to be diagnosed by a mammogram. It’s wise to take a step back and try to understand what that means for you.”
She researched online and learned about IORT and the clinical trial at Avera, and made an appointment with Dr. Reiland.
“Having the radiation done precisely at the tumor site during surgery made so much sense to me, rather than having to radiate through the skin. It’s amazing technology,” she said.
And, Baseley is glad that she has helped to advance medical science to benefit future generations, maybe even her own daughter. “Knowing I was going to be part of the big picture in the future of breast cancer treatment was exciting for me. It makes me very proud.”