IORT a Way to Complete Breast Cancer Treatment in One Single Day

One thing that deters patients who are undergoing cancer treatment for breast cancer is that they need to go for treatment for prolonged duration of time. However, newer technology has changed it for some early breast cancers. A single dose of radiation therapy given during lumpectomy surgery — called intraoperative radiation therapy (IORT) — offered about the same outcomes for early-stage breast cancer as traditional whole-breast radiation therapy given after surgery, according to a study published in British Medical Journal. So, 30 days of Treatment can be completed in 30 minutes.

Traditional Whole-Breast Radiation Therapy

Traditionally whole-breast radiation therapy is used on most people who have lumpectomy or breast conservation surgery to remove breast cancer. Radiation after lumpectomy aims to destroy any cancer cells that may have been left in the breast after the cancer has been removed.

As its name suggests, whole-breast radiation therapy aims a beam of radiation at the entire breast affected by cancer.

It has been proven by research that short- and long-term traditional radiation is effective reducing cancer from coming back. However, the drawbacks of traditional radiation therapy include daily trips to the hospital or cancer center to get treated — often 5 days a week for 3 to 6 weeks. Maintaining this schedule can be difficult for many people as even the caregiver time is needed. Traditional radiation therapy also may expose healthy tissue, such as the heart and lungs, to more radiation.

The idea of IORT is to circumvent these issues, but, give the same results.

What is Intraoperative Radiation Therapy (IORT)?

Majority of breast cancers come back in the breast tissue very close to the first cancer.

Intraoperative radiation therapy in short called IORT, is radiation therapy given during lumpectomy surgery in 20-40 min, right after the cancer has been removed while the patient is still under anesthesia. While the underlying breast tissue is still exposed, a single, high dose of radiation is given directly to the area where the cancer was.

Besides being more convenient than a traditional radiation therapy schedule, the researchers who developed intraoperative radiation think it can better avoid exposing healthy tissue to radiation.

Still, studies looking at whether intraoperative radiation therapy is as good as whole-breast radiation given after surgery in selected settings. More than 250 centres worldwide have adopted IORT and are giving the benefit to the patients.

Advantages of IORT

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Quick completion of treatment in 1 day

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Adds only 20-40 min to surgery

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High precision

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No radiation to normal tissue

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No Pain or complications of radiation

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No difference in cancer cure results.

Large Research Study

The study, called the TARGIT-A study, included 2,298 women age 45 and older who had been diagnosed with early-stage breast cancer from 2000 to 2012 who underwent lumpectomy. The study included women who lived in 10 countries, including the United Kingdom, Australia, the United States, Canada, and countries in Europe.

The results showed no real difference between the two types of radiation schedules in

local recurrence-free survival (how long the women lived without the cancer coming back in the same breast)
distant disease-free survival (how long the women lived without the cancer coming back in a part of the body away from the breast, such as the bones or liver)
overall survival (how long the women lived, whether or not the breast cancer came back)
breast cancer mortality (how many women died from breast cancer)

They wrote: “The long-term results of this trial have shown that risk-adapted single-dose TARGIT-IORT [targeted intraoperative radiotherapy], given during lumpectomy, can effectively replace the mandatory use of several weeks of daily postoperative whole-breast radiotherapy in patients with breast cancer undergoing breast conservation,”

Who are the patients eligible for single day treatment?

With IORT it is possible to give single day treatment for breast cancer in selected cases.

Case Selection (Internationally accepted Guideline):

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Women > 50 years old

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Tumours measuring 2 cm or less

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HR+

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Without lymphovascular invasion

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No nodal involvement

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Negative margins

For these patients we can perform the lumpectomy procedure along with sentinel node biopsy for lymph nodes followed by IORT. Traditionally this would take approximately few months (approximately 8-12 weeks) to complete as there has to be a gap between surgery and radiation. By doing IORT (in 20-40 min) the entire process is completed in 1 day.

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Can IORT be used in all breast cancer?

Many breast cancer patients may not be eligible for single dose IORT due to various factors and may need the traditional whole breast radiation therapy. However, even among these patients there is a definite scope and advantage of using IORT. There are many scenarios the benefits that have been described in these patients as well. Along with whole breast radiation usually additional radiation boost is given to the area where cancer was there. This can be done more effectively using IORT with following advantages:

IORT as a boost to the tumour area offers better precision

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Oncoplastic reconstruction is used for cosmetic purposes the breast tissue is moved to close the gap or tissues from other parts of the body are used. In this scenario the original breast tissue is difficult to identify. When we give IORT at the time of surgery there is no confusion about the location of tumor. The radiation can be delivered precisely in the presence of operating surgeon. The radiation error is completely eliminated.

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Saves 4-8 days of tumor bed boost.

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Can also be considered in previously radiated patients as conventional EBRT may be difficult.

So, every breast cancer patient can benefit from opting for IORT, even when additional radiation has to be given.

You could learn more about IORT from the Intrabeam TARGIT website.