New procedure Combines Radiation with Surgery: Intra-Operative Radiation Therapy
James Wheeler, MD, PhD
Goshen Center for Cancer Care
Helping breast cancer patients receive radiation sooner
June 7, 2017, physicians at Goshen Hospital treated their first three patients with a new form of radiation therapy called Intra-Operative Radiation Therapy (IORT). In the 1970s and 1980s, results from randomized clinical trials demonstrated that patients with early stage breast cancer have identical survival with breast conservation surgery and post-operative radiation therapy to the whole breast as compared to women who underwent a mastectomy.
The typical course of radiation was five to six and a half weeks. Although radiation treatments were effective at controlling the cancer, the long course of radiation therapy was a burden to working women and often was not feasible for women who did not live close to a radiation therapy center.
Many women can now be treated with shorter radiation schedules, such as with 16 treatments in 3 weeks or twice daily for five days.
Moving to one targeted treatment
Clinical trials in Europe demonstrated that some patients could be treated with only a single dose of radiation, delivered in the operating room at the same time the surgeon removes the tumor (IORT).
The TARGIT-A trial enrolled 2,298 women. Those women receiving IORT and no other radiation therapy had a five-year local recurrence rate of only 2.1 percent. IORT was not as effective if the tumor was first removed and then, a few weeks later, the IORT was delivered as a second procedure.
Identifying ideal candidates for IORT
Women who are suitable for IORT must meet all of the following criteria:
- At least 50 years old
- Tumors ≤ 2 centimeters with good negative margins
- Invasive ductal histology
- Estrogen receptor positive tumors
- No cancer in the axillary lymph nodes
Patients who have adverse pathology features may need additional radiation therapy, typically with the shorter, three-week schedule.
There has been a growing trend towards shorter courses of radiation to reduce travel time and the burden on the patient. The ultimate convenience is to receive a single dose of radiation while in the operating room at the time of tumor removal. The surgical and radiation oncologists work together for the benefit of our patients. We are very excited to be able to provide this new treatment technique. We have a prospective registry collecting information on the treatment effectiveness, cosmetic results and patient quality of life for our patients who choose IORT.