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Jun 12

IORT, A New Option in Breast Cancer Surgery

breast cancer awarenessBreast cancer is one of the most common malignancies that affect American women. In fact, it is second only to skin cancer, with an estimated 330,000 new cases expected to be diagnosed in the U.S. this year. About 12.5% of all American women will develop breast cancer sometime in their lives.

The good news is that breast cancer rates in the U.S. began decreasing about the year 2000. Possibly, this decrease has been due to the reduced use of HRT (hormone replacement therapy) after the results of a large study were published (see Evidence-Based Medicine). It is very encouraging to note that the death rate from breast cancer has also declined. Early detection through public awareness campaigns and early screening programs has played an important part in producing this outcome. Also, improved treatment with drugs, radiation therapy and surgery, especially minimally invasive breast surgery, have made cure rates for breast cancer much higher. More than 3.1 million American women who have a history of breast cancer are alive today (including those currently being treated and women who have finished treatment).

These are huge improvements over past statistics, and the progress continues every day. Wherever possible, lumpectomy has replaced mastectomy as surgical treatment for breast cancer. Lumpectomy is a surgical procedure in which only a part of the breast is removed. The removed breast tissue includes the tumor and a small margin of healthy tissue surrounding it. Thanks to the early detection programs mentioned above, many women diagnosed with breast cancer are candidates for lumpectomy.

Successful lumpectomy depends on the location of the cancer and its size compared to that of the breast.  A surgeon may recommend lumpectomy if the breast cancer is restricted to only one part of the breast and is relatively small compared to breast volume. As you can imagine, minimally invasive breast surgery, and a successful lumpectomy involves a very skilled team of operating room doctors and nurses.

In the past, radiation therapy has been routinely recommended after lumpectomy. This radiation therapy reduces the risk of the cancer reappearing after lumpectomy.  These post-surgery radiation treatments have varied according to the patient’s history and other considerations, but a three to six-week course of daily whole breast radiation was not uncommon. Obviously, this adds a considerable burden to the breast cancer patient.

IORT, or Intraoperative Radiation Therapy, offers an alternative to post-surgical radiation for many women. In this procedure, the radiation is delivered during the surgery itself, directly into the area where the tumor has been removed. Following IORT, most patients will not require added radiation therapy at a later time. IORT offers several advantages over past options-

  • The entire dose of radiation is given immediately at the time of lumpectomy, while the patient is still under anesthesia. This allows a return to normal life more quickly.
  • Convenience for patients. In the past, after healing from surgery, breast cancer patients would undergo radiation therapy for five days a week for as long as three to six weeks. Typically, no return trips for radiation therapy are required for IORT
  • The radiation therapy is targeted, given directly and internally to the areas of the breast with the greatest risks of cancer recurrence. The nearby tissue is spared exposure to radiation.
  • Fewer side effects, as IORT decreases the occurrence of rashes and skin irritations compared to past radiation therapy.
  • A “team of experts” approach. The oncologist is in the operating room with the surgeon, customizing the treatment for every patient.

Like all surgical treatments, IORT is not suitable for all patients. Only patients in the early stages of breast cancer, with small tumors are candidates for IORT. This reinforces the importance of early detection and treatment. A patient’s age is a factor; typically, women aged 50 or older are candidates for IORT although some studies have included women as young as 40. IORT is usually aimed at eliminating the need for post-surgical radiation, but in some cases, IORT may be combined with traditional radiation therapy. This may be the case for patients at greater risk of recurrence or those who have more extensive breast cancers. To minimize the risk of local recurrence, a patient found to have larger, more extensive breast cancer may need to undergo whole-breast radiotherapy in addition to IORT.

Minimally invasive breast surgery, Intraoperative Radiation Therapy and lumpectomy all add up to significant advances in treatment for breast cancer patients. Combined with the public awareness and early detection campaigns, these therapies offer a much brighter outlook for women at risk of breast cancer. If you or a loved one has been diagnosed with breast cancer, discuss the options with your specialist and consider this as one possibility.

As always, if you have any question about the areas included in minimally invasive breast surgery, bariatric surgery or general surgery, please contact our office. You may use Contact Dr Birkedal or phone us at (386) 231-3530. Our offices, located in Daytona, New Smyrna and Palm coast are all part of the Florida Hospital Network.

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