Welcome to October’s 4th Edition!
A Look at Intraoperative Radiation Therapy
By: Avantika Samanta
In a year, approximately 42,690 people die from breast cancer. Many lives are lost due to the limited options for treatment. Treatments including medications, Conventional Radiation treatments, and certain surgeries like mastectomies or lumpectomies all exist, but it can be time consuming and expensive. In recent journals, Intraoperative Radiation Therapy during lumpectomy has shown promise for helping eligible patients. There are several benefits for patients, but there are still questions being asked due to it being a new and upcoming procedure. Intraoperative Radiation Therapy is a slightly complicated form of treatment, yet it offers hope for the future of breast cancer treatments.
Before the Intraoperative Radiation Therapy occurs and the radiation therapy is administered, the patient first has to go through a lumpectomy. A lumpectomy is a surgery that removes cancer or another form of abnormal tissue from a patient’s breast. Unlike a mastectomy that removes all of the breast tissue from the breast, only a part of the breast is removed during a lumpectomy. A lumpectomy can help find or remove cancer and is usually administered for women in the early stages of breast cancer. Radiation after a lumpectomy is common, however this treatment is different. Intraoperative Radiation Therapy( IORT) is unlike conventional radiation therapy since it is administered internally during lumpectomy surgery right after the cancer has been taken out. While the underlying breast tissue is still exposed to a single high dosage of radiation, it is given directly to the area where the cancer originally was. Conventional radiation therapy is administered externally and is able to be as precise as the intraoperative therapy is.
There have been several studies in the past years that support intraoperative Radiation Therapy. First, the Intraoperative radiotherapy versus external radiotherapy for breast cancer (ELIOT) trial, which used highly energized electrons to deliver radiotherapy to the lumpectomy cavity after the surgery. The study compared IORT to Whole Breast Irradiation(WBI) and IORT happened to do better by having lower rates of dryness, hyperpigmentation, pulmonary fibrosis, and more. The Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer,
(TARGIT-A) trial was similar to ELIOT but had slightly different dosages and processes. Results of the TARGIT trial show IORT to be better than WBI but there wasn’t much of an impactful difference. One more trial, the Implementation of an HDR brachytherapy-based breast IORT program (CT-HDR-IORT), is a novel method developed by the University of Virginia Health System dubbed PB-IORT. PB-IORT combines a high dose rate of brachytherapy and CT scans, which is a medical imaging device, to deliver a single dose of customized radiation at the time of the lumpectomy. This method has proved itself to be feasible and safe yet it is only in Phase II, so it is still being explored.
Along with showing capability scientifically, the patient’s response has been positive. Patients are more inclined to undergo and comply with getting the IORT treatment rather than the WBI treatment. IORT is more convenient since it can be completed in a single session, compared to the usual six week session for conventional radiation therapy.Because it only targets the specific area, it has shown to have fewer side effects. At the moment, it is more of an efficient cost since it is much less expensive than conventional radiation therapy.
Although this therapy shows large amounts of promise, there are still several questions. There are concerns as to whether or not this treatment is entirely safe. All possible side effects aren’t currently known since it is still in its early stages. Questions are also arising about the amount of accessibility, who this treatment can be administered to and at what cost.It is also unknown if this method is completely useful. The method may not be a suitable long term solution since this therapy might not be able to stop the cancer from returning. More questions need to be asked and more testing needs to be done before this treatment can reach its full potential, or even be remotely plausible. However, the future is bright thanks to this amazing discovery.
The Journey Through Breast Cancer Surgery
By: Vanessa Cano
Breast cancer treatment has come a long way. Breast cancer was defined as incurable once the case was “cool to touch, building, and spread all over the breast”, by the Egyptians in 3,000-2,500 B.C. The ancient Greeks described their treatment as a divinity exhorted for breast madlies. Somewhere in this journey, Galen – a 2nd century Greek doctor – stated that breast cancer was the accumulation of black bile in the blood and was a systemic disease. Ancient physicians would link menstruation to cancer with not much evidence. However, modern medicine has allowed the development of breast cancer treatment to improve immensely and will likely continue to improve. The main method of treatment today is surgery, including breast-conserving surgery and mastectomies.
Breast-conserving surgery is defined as the removal of the area of the breast infected with the cancer. With this option, healthy tissue surrounding the cancerous location may have to be removed in case of future cancerous spread. Those who decide on this course of treatment also have a higher chance of needing to undergo radiation therapy. However in early stage cancers, women may also choose Breast-Cancer Surgery (BCS) or mastectomy.
Mastectomy is the removal of all breast tissue, including nearby tissues. Mastectomies include a few variations: double mastectomies, modified radical mastectomies, radical mastectomies, and skin-sparing mastectomies. Modified radical mastectomy is the removal of all breast tissue, including the papilla and lymph nodes in the underarm. With this surgery, all chest muscles stay intact, and is the best option for invasive breast cancer. Radical mastectomy is the same as the modified radical mastectomy, but including the chest wall muscles under the breast – this causes more disfiguration. Nowadays, this surgery is quite uncommon, unless the cancer has spread into the chest muscles under the breast. Lastly, skin-sparing mastectomy includes the removal of the papilla skin, areola, and area where the tumor was located. This leaves the rest of the tissue, which can be used in the future for breast reconstruction.
These are not the only surgeries involved in breast cancer treatment. Specifically, the lymph nodes may have to be removed during surgery in order to test for cancer spread into the underarm. Sentinel lymph node biopsy (SLNB) is the removal of the lymph node under the arm, whereas ancillary lymph node dissection (ALND) is the removal of multiple lymph nodes.
In guiding breast cancer surgery, if the tumor cannot be felt or is difficult to locate, the surgeon may use a wire localization technique. Once the breast tissue is anesthetized, an ultrasound is used to insert a thin hollow needle through the abnormal area. The top of the needle is led to the cancer and a wire is inserted through the center of the needle. A small hook keeps the wire in place, allowing the surgeon to use the wire as a guide to perform the tumor removing procedure. Though this technique has been proven effective, it is new and not performed in many facilities.
It is important to become informed about the large number of options in breast cancer treatments. The diagnosis of breast cancer highly affects not only the body, but the mind, too. With time and research, breast cancer patients may find better treatments through clinical trials.
Work Cited:
A Look at Intraoperative Radiation Therapy:
Dutta, Sunil W, et al. “Intraoperative Radiation Therapy for Breast Cancer Patients: Current Perspectives.” Breast Cancer (Dove Medical Press), Dove Medical Press, 18 Apr. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5402914/
N/A, N/A. “Intraoperative Radiation Therapy During Lumpectomy Seems as Good as Traditional Whole-Breast Radiation Therapy for Early-Stage Breast Cancer.” Breastcancer.org, 13 Oct. 2020, www.breastcancer.org/research-news/iort-during-lx-vs-whole-breast-for-early-bc
N/A, N/A. “Studies Show Risks and Benefits of Intraoperative Radiation Therapy.” Breastcancer.org, 5 Feb. 2015, www.breastcancer.org/research-news/20131203
Rao, Roshni. “Intraoperative Radiation Therapy for Breast Cancer.” Intraoperative Radiation Therapy for Breast Cancer | Columbia University Department of Surgery, 0AD, https://columbiasurgery.org/conditions-and-treatments/intraoperative-radiation-therapy-breast-cancer
Vaidya, Jayant S, et al. “Long Term Survival and Local Control Outcomes from Single Dose Targeted Intraoperative Radiotherapy during Lumpectomy (TARGIT-IORT) for Early Breast Cancer: TARGIT-A Randomised Clinical Trial.” The BMJ, British Medical Journal Publishing Group, 19 Aug. 2020, www.bmj.com/content/370/bmj.m2836
The Journey Through Breast Cancer Surgery:
“Surgery for Breast Cancer.” Breast Cancer Surgery, American Cancer Society, 18 Sept. 2019,
http://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer.html.
Pichardo, Gabriela. “Breast Cancer Surgery Options.” Breast Cancer Surgery, WebMD, 26 Jan.
2020, http://www.webmd.com/breast-cancer/breast-cancer-surgery-options.
Breast Cancer: Types of Treatment, Cancer.Net, Aug. 2020,
http://www.cancer.net/cancer-types/breast-cancer/types-treatment.
Lakhtakia, Ritu. A Brief History of Breast Cancer, Sultan Qaboos Univ Med Journal, May 2014,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997531/.
DeSantis, Carol, et al. Breast Cancer Statistics, 2013, American Cancer Society, 1 Oct. 2013,
acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21203.
Medical Wonders 