In the 1970’s, women began having lumpectomy with radiation instead of mastectomy for the surgical treatment of breast cancer. For this treatment a woman has her breast cancer removed in the operating room as a lumpectomy, then, about 4 weeks after surgery, when all healing is complete, she undergoes radiation. Radiation traditionally has been the delivery of electron rays to the whole breast given in small doses every day, 5 days a week for 6 weeks. Over the years, it has been shown that there is no difference in survival if a woman has lumpectomy with radiation, versus mastectomy. Today, about 90% of women with early stage breast cancers can be treated safely and effectively with lumpectomy and radiation.
With that kind of information, it would seem that most women with breast cancer would be undergoing lumpectomy with radiation. Unfortunately, in the United States, this is not the case. Depending on the region, the rates of lumpectomy with radiation is only about 50-70%. There are many reasons why this is the case. Sometimes women have the misconceptions that undergoing mastectomy will remove all their risk of developing a recurrence, or having the breast cancer spread. There are women who are well known who have publicized their own choice to undergo mastectomy, and as in everything else in our US culture, it has become a “fad” for some women. They have the mistaken belief that mastectomy is the only safe treatment for their breast cancer. And yet for other women, the radiation treatments, where they would have to travel or leave a hectic work schedule to undergo radiation for 6 weeks is more than they care to do, and mastectomy seems the only option for them.
In the late 1990’s, breast cancer specialists recognized that radiation lasting 6 weeks was an obstacle for women choosing lumpectomy and radiation and started developing other forms of breast radiation that would be as effective as 6 weeks, but take much less time for the patient.
Today we have several different types of radiation options that give radiation only to the area of the breast where the breast cancer was, destroying any ‘rogue’ cancer cells that may still be present after surgery. This greatly reducing the chances the breast cancer would grow back. The best advantage is that the treatment time is reduced from 6 weeks, to either 3 weeks, one week and even one day.
This approach is lumped under the term “Brachytherapy, or Accelerated Partial Breast Irradiation (APBI)”. There are now many forms of APBI, and there are guidelines and recommendations as to which patients are best suited to undergo these treatments.
Intra Operative Electron Radiation Therapy
IOERT is one of the radiation treatments that falls under the description of accelerated partial breast irradiation. IOERT is the process of delivering radiation to the tissue in the breast at the time of surgery. During the breast cancer operation, the cancer is removed just as it is usually, the tissue is then brought together to fix the defect where the cancer was done. Then, before the skin is closed, a portable radiation machine is wheeled into place and a dose of radiation is given to the breast tissue most at risk. Because we use electrons, the dose is very efficient, and it takes only 1-2 minutes to treat the tissue. The incisions are closed and the patient has completed her operation. Depending on the individual case, the patient will then either need no further radiation or go on for 3 or 5 weeks of radiation. Whether a patient needs more radiation depends on many variables. The patient’s age, the size of the tumor, the type of the tumor to name a few. All of these factors are considered well before the surgery and the patient is aware how much radiation she will receive before she goes to the operating room.
In all cases using intra operative radiation with electrons, we can ensure the tissue most likely to harbor any lingering cancer cells are treated immediately after the tumor is removed. Studies are now being published that show in patients that are good candidates for this procedure, the chances they will have the tumor regrow after surgery and IOERT is about 1.5% after 5 years.
The use of the Mobetron device has revolutionized the quality of breast cancer care, and made a tremendous difference in patient satisfaction.