November 28, 2022 by John Fernandez
Radiation Therapy in Minutes
A breast cancer diagnosis is daunting enough, and many women face weeks of time-consuming radiation therapy after surgery. But that didn’t happen to Carmen Fernandez after early-stage cancer cells were detected in a pimple- size lump in her left breast.
Baptist Health Medical Group breast surgeon Cristina Lopez-Peñalver, M.D., offered Ms. Fernandez “a new and exciting treatment option” as part of a national research study on intraoperative radiation therapy, or IORT, a one-time radiation treatment that occurs during surgery.
“I thought that was marvelous,” said Ms. Fernandez, a Miami substitute schoolteacher.
The study’s principal investigator for Baptist Health, Dr. Lopez-Peñalver works with radiation oncologist Maria- Amelia Rodrigues, M.D., to perform the outpatient surgery and radiation therapy in a single procedure that lasts about 90 minutes. Select women with early-stage breast cancer having a lumpectomy may qualify to be part of the study, which uses Doctors Hospital’s new IORT machine.
60% are Early-Stage Cancers
Sixty percent of the quarter of a million breast cancer cases diagnosed annually in the United States are early-stage cancers. That means this expedited treatment could help thousands of women like Ms. Fernandez return more quickly and easily to their normal lives.
“My recovery has been easy,” Ms. Fernandez said less than a week after her surgery and IORT. “I would recommend this treatment if your doctor says you qualify. My tumor was small and caught early. What I learned is that cancer is something that, if caught early, has a simple solution.”
IORT targets the tumor site during surgery in contrast to standard breast cancer radiation therapy, which radiates the whole breast and requires five weekly treatments for five to seven weeks.
For many women, already balancing work and family, that demanding schedule only adds to their stress. In addition, lack of time, money and transportation, as well as difficulty accessing a treatment facility, are factors in the reasons 20 percent of North American women do not follow through with the recommended radiation after undergoing a lumpectomy. As a result, they’re at increased risk of cancer recurrence, Dr. Lopez-Peñalver said.
“My hope is that in select patients, this more convenient treatment will increase the rate of women having breast-conservation surgery, decrease the rate of mastectomies and increase the treatment compliance rate of women having lumpectomies,” Dr. Lopez- Peñalver said.
IORT as Effective as Whole Irradiation
Previous studies on IORT have found it to be as effective as whole breast irradiation in preventing breast cancer recurrence at 5 years of follow up.
Though Ms. Fernandez also was a candidate for another type of radiation therapy called brachytherapy, a shorter procedure than the weeks-long standard radiation treatment, that option was also less convenient and more time-consuming. It involves “seeds” of radiation inserted into a special balloon catheter twice a day for five days. The catheter remains in place throughout the treatment.
“It still means taking time off twice a day and, when you factor in placement of the catheter and planning of the treatment, the patient is dealing with a catheter in her breast for about seven days. Plus she can’t shower during that time period.” Dr. Lopez-Peñalver said. “It isn’t a painful treatment, but it isn’t convenient, either.”
With IORT, a radiation oncologist administers a concentrated dose of radiation directly to the tumor site immediately after the surgeon has removed the tumor. This concentrated dose helps destroy microscopic cancer cells that might remain. Because the tumor site is typically at the highest risk for a cancer recurrence, delivering radiation to the site as soon as possible is advantageous.
IORT allows the radiation oncologist to administer a precise dose of radiation to the tumor site while shielding healthy tissue and nearby organs, including the lungs and heart, from radiation. This means a higher radiation dose can be delivered safely.
For Ms. Fernandez, “the procedure went extremely well,” Dr. Lopez-Peñalver said. “She has completed her local treatment and has an excellent prognosis.”