Spokane Journal of Business

Breast cancer treatment said

Radiotherapy delivered right after lumpectomy effective, physicians say

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Presbyterian Hospital/Weill Cornell Medical Center, of New York City, has begun offering what's called Intrabeam radiotherapy to women with early-stage breast cancer, an innovative radiation treatment delivered in a single dose at the time of surgery.

Women with early-stage breast cancer often have breast-conserving surgery, otherwise known as a lumpectomy, to remove a cancerous tumor. Lumpectomy is followed by a regimen of daily doses of radiation therapy to the entire breast, generally lasting six to seven consecutive weeks.

"Intrabeam radiotherapy may be an effective alternative to a six- to seven-week regimen following surgery for select patients because it allows us to target precisely any remaining cancer cells right inside the tumor bed, where the tumor is most likely to recur," says Dr. Mary Katherine Hayes, clinical director of radiation oncology at the hospital and associate professor of clinical radiology and radiation oncology at Weill Cornell Medical College.

Immediately following removal of the tumor, while the patient is still on an operating table, the Intrabeam applicator's small, cylindrical tip is placed inside the tumor cavity to deliver a superficial dose of radiation for 20 to 30 minutes, while limiting exposure to healthy surrounding tissue and organs. After the applicator is removed, the surgical incision is closed.

"Our ability to use this radiation technique in such a timely manner may add to its effectiveness since the area in need of treatment can be directly visualized at the moment the tumor is removed," says Dr. Alexander J. Swistel, attending breast surgeon at the Iris Cantor Women's Health Center at the hospital and associate professor of clinical surgery there.

The hospital says this alternative to conventional full-breast radiation therapy is in step with the hospital's practice of tailoring partial breast cancer treatments to a growing number of patients with small, early-stage tumors. Eliminating an additional six to seven weeks of radiation therapy is particularly convenient for patients who don't live near a hospital.

A 10-year randomized clinical trial of intraoperative therapy for breast cancer found that for certain patients, single-dose radiotherapy delivered at the time of surgery yielded the same results as conventional full breast radiation delivered over several weeks.

The TARGIT-A Trial, published in The Lancet in July 2010, studied only the Intrabeam system and was the largest randomized clinical trial conducted in this field, with more than 2,000 women in multiple countries enrolled.

While Intrabeam is limited to a select group of patients with small tumors, if tissue samples removed during surgery prove more aggressive than preliminary tests revealed, the patient still is able to undergo conventional full-breast radiation. However, the patient wouldn't need to undergo the final five-day phase of conventional treatment, known as boost therapy, which targets the tumor bed with external radiation.

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