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October 23, 2019

IORT can be a convenient and effective option for women with breast cancer.

By Ulrich Hermanto, M.D., Contributor | Oct. 23, 2019 at 6:00 a.m.

IORT for Early Stage Breast Cancer

Breast cancer affects 1 in every 8 women in the United States. Due to the awareness of the disease and importance of screening, most women are diagnosed with early stage breast cancer (stages I and II). For these individuals with early stage breast cancer, a mastectomy, which involves the surgical removal of the breast, has long been the standard treatment. This may no longer be the case.

Today, breast conservation therapy, which removes the tumor (this is also known as a lumpectomy) and some breast tissue, preserves the majority of the breast. This is then followed by breast radiation therapy. The combination is just as effective as a mastectomy.

While radiation therapy (also called external beam) is a brief painless daily treatment, most of our patients need to have multiple weeks of treatment – three to four weeks for some, and six weeks for others depending on the tumor and individual patient. Side effects are usually temporary, often including fatigue, skin irritation, skin discoloration and breast swelling. There is also a lower risk of injury to underlying organs, such as the lung and the heart.

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Intraoperative Radiation Therapy for Partial Breast Irradiation

Intraoperative radiation therapy is a form of breast conservation therapy that involves a doctor delivering radiation at the same time of surgery, while a patient is still under anesthesia. Here’s how it works: Once a tumor is removed, a round applicator is fitted and carefully positioned in the tumor cavity, where low-energy X-rays treat the breast tissue closest to the tumor. This eliminates lingering cancer cells and spares remaining breast tissue and nearby organs from radiation exposure and side effects. The process takes less than an hour and allows people to have fewer treatments and potentially fewer treatment-related side effects.

As a radiation oncologist at Montefiore Yonkers Radiation Oncology in New York, I work closely with a team of breast surgical oncologists at St. John’s Riverside Hospital to provide IORT treatment to our early breast cancer patients.

As the first investigators in the New York City metropolitan area to adopt this exciting and new cancer treatment well over a decade ago, we were also one of the few groups in the country to enroll our patients on the TARGIT-A randomized trial that compared IORT to standard breast radiation therapy.

The published reports of this trial, which included more than 3,000 breast cancer patients from around the world, demonstrated that when selected patients with low-risk tumors receive IORT immediately following a lumpectomy, they do as well as people who receive standard whole breast radiation therapy.

The trial showed that local recurrence rates were low and not significantly higher than those who had whole breast radiation. People who received IORT therapy also had significantly less skin toxicity compared to people who received whole breast radiation. The immediate follow-up results from this major trial, as well as other clinical studies, indicate that IORT may, in the future, become a standard treatment option for early breast cancer patients.

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What’s Next for IORT?

We anticipate more results of the TARGIT-A coming out soon. We are also continuing to investigate additional benefits of IORT for our patients.

While it's important for us to know that patients receiving IORT for early breast cancer have a long-term benefit of controlling the tumor, we are also interested in knowing whether the single IORT treatment can help our patients return to their pre-treatment quality of life sooner than whole breast radiation patients following their treatments. To that aim, we are conducting a post-radiation treatment study based on patient reported surveys about their physical and non-physical quality of life to help answer this question.

From other clinical studies, we know that a radiation boost that specifically targets the tumor cavity (usually after the whole breast radiation) can further reduce the risk of local recurrence after surgery. To understand if patients might do as well or better with the addition of IORT to whole breast radiation, we are enrolling our “higher risk patients,” who have more aggressive stage I and II cancers, as well as people with advanced stage III cancer, on another international trial called TARGIT-B, which compares IORT to the conventional external breast boost.

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Where to Get the Treatment

IORT is now available at cancer centers and hospitals like Montefiore and St. John’s Riverside Hospital, which have the expertise and specialized radiation equipment. Breast cancer patients meet with the radiation oncologist and/or surgical oncologist to determine if they are eligible to have the treatment.

Nationwide criteria may include people having smaller hormone-sensitive (ER and/or PR positive) ductal type cancers without clinical lymph node involvement.

Ask Your Doctor

IORT can be a convenient and effective option for women with breast cancer. The one-time treatment at the time of surgery can help patients avoid weeks of daily radiation treatment after surgery. Ask your doctor if IORT is right for you.

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Ulrich Hermanto, MD, PhD, is Medical Director at Montefiore Yonkers Radiation Oncology.