New machine may reduce surgery for some breast cancer patients

Doctors at the University of Maryland have developed a new form of radiation treatment that may reduce or eliminate the need for surgery to remove tumors in patients with early-stage breast cancer.

The treatment, delivered by a machine called the GammaPod unveiled Monday at the University of Maryland Medical Center in Baltimore, could alleviate some of the many worries of those diagnosed with the disease.

The GammaPod, approved for use by the U.S. Food and Drug Administration in December, delivers strong doses of radiation more precisely to tumors. Doctors said it will not only reduce the number of radiation treatments a patient may need but will zap the cancer so thoroughly that there may be nothing left for surgeons to tackle.

“We believe this novel radiotherapy system has the potential to change the paradigm for treating early-stage tumors, negating the need for surgery in some patients,” said Dr. William F. Regine, chair and professor of radiation oncology at the University of Maryland School of Medicine and a co-inventor of the GammaPod with Cedric Yu, a clinical professor of radiation oncology at the university.

The effort, which began about a decade ago with a $3.5 million federal grant, reflects a general move toward reducing the amount of treatment for those diagnosed with early-stage breast cancer, who make up the bulk of patients. They tend to have good outcomes but have to endure a lot of treatment because doctors don’t know who will experience a recurrence of the disease.

Typically, early-stage cancer, which involves one dominant tumor that hasn’t spread, has been treated with surgery, then 16 or more rounds of radiation around the cancer site, plus chemotherapy to rid the body of any wayward cancer cells.

The field has moved to more minimally invasive lumpectomies over mastectomies, or full breast removal, more common about 20 years ago, said Regine, also chief of radiation oncology at Maryland’s Marlene and Stewart Greenebaum Comprehensive Cancer Center.

More recently some patients have been able to undergo radiation to just part of their breasts, but that process still could amount to months of treatments and side effects.

The GammaPod focuses multiple skinny rays of radiation from different directions to deliver a strong dose directly to the tumor, sparing nearby organs and tissue. It’s similar to a separate radiation treatment pioneered by Regine for hard-to-treat cancers such as breast cancers that have spread to lymph nodes and elsewhere.

The GammaPod will be marketed by a company formed by university doctors called Xcision Medical Systems LLC, based in Columbia, and the technology could be costly.

But Maryland doctors say overall treatment costs could be less than traditional care because only one to five radiation doses will be needed, according to Dr. Elizabeth M. Nichols, assistant professor of radiation oncology at Maryland and clinical director of the department of radiation oncology. Doctors are working with regulators to secure insurance coverage for the treatment option.

Though the machine has been approved for use by the FDA, more study is needed to show longer-term outcomes and determine which types of patients may be able to skip surgery. So, Nichols said, doctors at the medical center and community hospitals will enroll 200 or more patients in as many as five trials to continue testing the treatment.

Other hospitals also have agreed to enroll patients for study in the United States and Canada, including the University of Texas at Dallas, Allegheny General Hospital in Pittsburgh and Cancer Care Ontario.

The doctors also hope to test whether this kind of high radiation dose could boost the effectiveness of immunotherapy, which harnesses a patient’s own immune system. Past studies have shown radiation can make that treatment work better, even in advanced cancers.

“We’ll begin enrolling patients in the next couple of months for all the studies,” Nichols said.

Dr. J. Leonard Lichtenfeld, deputy medical director for the American Cancer Society, said there have been other attempts to reduce the amount of radiation patients require, but none have proven as effective as the standard care or have caught on.

If the GammaPod is proven effective, he said, it could greatly improve the quality of life for women by reducing the number of radiation sessions needed and by better preserving breast appearance. Fewer sessions also could expand options for women who otherwise would have full breast removals because they don’t have local access to radiation therapy and can’t leave home for months of treatment elsewhere.

“It’s early, but it’s interesting,” Lichtenfeld said. “It could mean improved quality of life for women with breast cancer with similar outcomes. … All these years later we’re still looking for better approaches. I hope they succeed.”

meredith.cohn@baltsun.com

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