New breast cancer treatment cuts five weeks of radiation to a matter of minutes
By Michael Bodley
The Baltimore Sun|
Oct 13, 2014 at 12:13 PM
Marlene MacGregor knew she was going to be a medical guinea pig, but she agreed anyway.
Doctors at Medstar Union Memorial Hospital offered the 70-year-old Nottingham resident several options after a biopsy revealed she had Stage 1 breast cancer. After surgery to remove the tumor, she was told traditional radiation therapy — in which a patient goes through weeks of daily radiation treatment — was the tried and true method, with over 30 years of data demonstrating low rates of the cancer reoccurring nearby.
But MacGregor found the prospect of so much energy-sucking radiation daunting, and she listened as Medstar's Dr. Maen Farha explained an alternative still being studied that is called intraoperative radiation therapy, or IORT.
Widely used in Europe after early clinical trials showed the treatment successfully can condense five to six weeks of radiation therapy into one intense burst targeted in the tumor space.
The procedure's supporters credit it with reducing the painfully long process of radiation, but it's not yet clear if produces the same long-term results.
It worked for MacGregor, for now, though making the initial decision was daunting.
"It's really a scary thing when they tell you have cancer," she said of the waiting period between finding the biopsy and her initial meeting with Farha.
IORT now is increasingly being used around the United States because as studies continue to show it can significantly reduce the time and harm of traditional radiation.
Typically women who have lumpectomies to remove small tumors would be given an extended regimen of radiation to their entire breast to reduce the chance the cancer returns. But that's an overwhelming commitment that has led some women to miss appointments or have more radical mastectomies to avoid the treatment altogether.
The big blast from IORT is used once immediately following surgery in the space left by the tumor to eradicate microscopic cells left behind by the scalpel. It takes less than an hour.
Two studies published last year found survival rates were the nearly the same with IORT and traditional radiation after five years, and there was less damage to surrounding areas by IORT. But IORT patients did have more cancer recurrences. Researchers said patients need to be tracked over longer periods to see the full value of the newer treatment.
"It's something that only time will tell, but so far, the results have been very promising," said Dr. Benjamin Laser, a Mercy radiation oncologist.
He and Farha also said the procedure isn't for everyone. The tumors must be small and the cancer must not have spread, meaning the patients are candidates for lumpectomies and don't need their full breasts removed. Patients also typically are older and more susceptible to the side effects of ongoing traditional radiation treatment.
"You obviously don't want to push the ticket in these things, unless you're satisfied that this is a really good candidate and the patient understands what's going into it," Farha said.
Other doctors, however, have urged caution, including Dr. Richard Zellars, assistant director for clinical trial accrual at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.
Though he called the research "promising in a theoretical sense," Zellars said 10 years is a safer benchmark, and the data's just not there yet.
Hopkins has not yet approved the procedure, but Zellars expressed interest in joining a growing IORT clinical trial that includes Union Memorial, Mercy Medical Center and Greater Baltimore Medical Center and adding to the mounting data about the safety of the procedure.
In the meantime, he said patients should be given all the information available on the risks and benefits, as well as alternatives, he said.
"My fear is that many of these women are told that it's perfectly OK, it's been proven, and we have follow up," Zellars said. "But I would argue that we don't have long enough follow up."
Dr. Neil Friedman, director of the Hoffberger Breast Center at Mercy, said he handpicks patients who are a good fit for the procedure. So far, the feedback from them has been good, he said.
"If you can get your radiation in 30 minutes in the operating room, and you wake up and you're done, then that's a home run," said Friedman, adding that side effects have been limited to some scar tissue and soreness.
The choice was an easy one for Laura Robinson, 49, who watches her7-year-old son and almost a dozen other children out of her Baltimore home through Future Scholars Learning, a licensed day care she owns and operates.
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Robinson, who was diagnosed with Stage 1 breast cancer at Mercy earlier this year, said she easily could have become one of the thousands of Americans each year who don't complete the recommended radiation cycle due to time or money.
"All that radiation — I wouldn't have been able to watch my children," she said. "I would not be able to take care of my home and would just fall behind on life."
Robinson and MacGregor both walked out of the hospital after a couple of hours of recovery. In the following weeks, they said they noticed lumps of scar tissue and occasional aches in their breasts.