Her Doctor’s Perseverance Paid Off for Stroke-Limited Breast Cancer Patient

Mrs. Lee, who was born in St. James, Jamaica and has lived in South Florida with her family for the past 35 years, spent her entire career caring for others as a registered nurse. But after suffering a stroke in July 2020, just as the coronavirus pandemic was taking hold, her work and her life came to a sudden halt, much like the rest of the world, it seemed. And she would now have to depend on others, including her husband Steve and daughter Monique, for her care.

Because of her condition, and because the pandemic had turned the world upside-down, Mrs. Lee neglected to get her annual mammogram in 2021. It was a decision she would come to regret when earlier this year she had a mammogram and it revealed calcifications in her left breast. A subsequent biopsy confirmed that Mrs. Lee had cancer. She underwent a lumpectomy to remove the tumor soon after her diagnosis and then saw Dr. Botero for the next phase of her treatment, radiation therapy.

“When I first saw Mrs. Lee in May, she had just been diagnosed with early-stage, high-grade ductal carcinoma in situ, or DCIS, a very common form of breast cancer, and she had already had her surgery,” Dr. Botero recalls. Although it’s possible the cancer could have been caught earlier had Mrs. Lee had her regularly scheduled mammogram in 2021, Dr. Botero says it’s a good thing it was caught when it was. “It was one step away from becoming invasive cancer and it had a high likelihood of recurrence.”

Roughly half of tumors that do recur come back as invasive cancer, according to Dr. Botero, which means the patient will have to undergo additional treatment, including additional surgery, chemotherapy, and more radiation. In Mrs. Lee’s case, the goal was to prevent recurrence by treating her entire breast with external radiation therapy (RT).

For more than 20 years, multiple studies have proved the success of adding radiation therapy after the lumpectomy for DCIS, decreasing the recurrence of the breast tumor by 50 percent. So Dr. Botero knew she would have to find an alternative approach to the protocol Miami Cancer Institute typically employs for breast cancer patients who require RT.

Finding a solution that worked

“Normally, we offered RT to the entire whole breast, utilizing different techniques. For the one we call “prone” position, we have the patient lay flat on their stomach on a special table that allows just their breast to hang underneath where we can then safely deliver a precise dose of radiation,” Dr. Botero explains. “This protects the patient’s heart and lung from any toxicity associated with the RT. But, because of Mrs. Lee’s physical limitations from her stroke, this approach wasn’t possible.”

Dr. Botero then tried the “supine” position, having her patient lay on her back with her arms raised so that radiation could be delivered that way, but Mrs. Lee was unable to raise her arms. “She has significant difficulty with her range of motion, so that wasn’t going to work either,” she says. The next option Dr. Botero considered was partial breast radiation, which she says has proved to be a well-known technique for treating early-stage cancer and is as successful as whole breast radiation in decreasing potential tumor recurrence after surgery.

With partial breast radiation, a catheter is inserted in the cavity left when the tumor was removed during the lumpectomy, Dr. Botero explains. Radiation is then delivered via a beam directly to the cavity, along with a small portion of the surrounding margins. This approach, too, would prove unworkable. “Unfortunately, her arm was interfering with the angle of the beam and she was unable to move it high enough to allow the beam of radiation to target the lumpectomy cavity,” Dr. Botero says.

At this point, Mrs. Lee’s only other option was accelerated partial breast radiation (APBI), which is delivered via brachytherapy. A catheter is temporarily inserted in the cavity left when the tumor was removed during the lumpectomy. The catheter is later loaded with a radioactive seed for a few minutes at the time of treatment. “It emits a precisely controlled ‘cloud’ of radiation throughout the cavity, killing any errant cancer cells that may have remained after surgery,” Dr. Botero says. “This technique spares healthy breast tissue and greatly reduces the patient’s risk of toxicity to the heart and lung.”

Another first for Baptist Health Cancer Care

The procedure, which is performed using local anesthesia, takes just a few minutes once the patient is in place, according to Dr. Botero. “It’s technically very easy to perform but it requires an experienced team.We’ve been using brachytherapy at Miami Cancer Institute for the past 10 years or more, and Mrs. Lee was the first patient to be treated with brachytherapy here at Baptist Health Cancer Care in Plantation.”

With brachytherapy, Dr. Botero says the patient feels minimal discomfort and has very few side effects – “no skin burning or peeling, and zero radiation to the heart or lungs.” Another advantage, she says, is that because they are able to safely deliver a much higher dose of radiation, total treatment time is greatly compressed.

“It’s a highly effective treatment, equally effective as the conventional whole breast radiation therapy. It is very well-tolerated, and it makes the entire experience far easier to manage for patients and their caregivers.”

Mrs. Lee’s treatment took place in late June and she continues to follow up with Dr. Botero, who says she is now cancer-free “and hopefully will be for many years.” For the next five years, to help prevent a recurrence of her cancer, Mrs. Lee will be on adjuvant hormone therapy with Tamoxifen, an estrogen-blocking drug that helps inhibit the growth of cancer cells.

Dr. Botero credits Mrs. Lee with being “a wonderful, engaged and very patient patient” who cooperated with everything they were trying to do for her. “She totally understood why we were trying so hard to make treatment possible for her, and she let us manipulate her in different positions for trying different treatments. Fortunately, we were able to find a solution that worked for her.”

More options for treating breast cancer and preventing recurrence

Mrs. Lee says she is very happy with her outcome and is thankful that Dr. Botero and others at Miami Cancer Institute in Plantation were able to help her. “Dr. Botero was very nice, pleasant and helpful, and she explained everything to me and my family,” she says. “I liked her because she was very encouraging, tenacious and determined” – the kind of person anyone facing cancer would want fighting for them.

Dr. Botero is thrilled that DCIS and overall early breast cancer patients like Mrs. Lee now have multiple options for treatment and for reducing the potential of recurrence. “I never dreamed we’d be able to offer patients such a quick and easy treatment,” she says. “There are many breast cancer patients who either are denied the benefit of RT because no other technology is available or who ended up getting a mastectomy instead of a lumpectomy because they were considered ‘not a candidate’ for radiation therapy. Now we have other options.”

“Every breast cancer patient is unique. As radiation oncologists, we work as part of a multidisciplinary team with the surgical oncologists and breast oncologists to individualize the patient’s treatment based on their characteristics and preferences as well as their cancer stage,” Dr. Botero says. “And here at Miami Cancer Institute, all of the latest radiation therapies are available under one roof.”