An NCI-designated Comprehensive Cancer Center
By City of Hope | August 31, 2017
Time Series of Microtentacles on a Breast Cancer Cell | City of Hope Time-lapse series of the surface of a breast cancer tumor. Courtesy of the National Cancer Institute.
When Ella Walter was diagnosed with breast cancer last year, she found herself frightened of what was to come. She imagined surgery and a painful recovery, followed by many weeks of grueling radiation treatments.
“Like anyone, I was very afraid,” said the 73-year-old La Crescenta, California, resident. “I didn’t really know what to expect.”  
Luckily, the cancer was detected early during a routine mammogram, so Walter was given an alternative — intraoperative radiation therapy (IORT), an innovative procedure that eliminates multiple radiation treatments and dramatically lessens side effects. She got a lumpectomy and just a single dose of radiation immediately afterward. Walter hardly missed a step.
“I was so lucky to be accepted into the City of Hope IORT program,” she said. “I had my lumpectomy and got my radiation while I was out. I woke up and I don’t remember feeling any pain, just a little discomfort when I laid in bed. I went home the same day and went right back to my regular routines. It was wonderful. I love my doctor and the staff at City of Hope.”
Since it was introduced at City of Hope in 2013, IORT has been a game-changer for 148 patients so far. Unlike traditional therapy involving daily external whole-breast radiation, IORT delivers one targeted treatment directly into the incision, right after the tumor is removed — killing stray cancer cells directly and immediately.  

A New Standard

Whole-breast radiation has been a standard — and highly effective — form of treatment for decades. Ongoing research and improvements have resulted in an up to 70 percent reduction in five-year recurrence risk, according to the American Society for Radiation Oncology, saving and improving the lives of millions of women.  
But it also comes with troublesome side effects, including fatigue, scarring and commuting to daily treatments over a period of five to seven weeks — a commitment that’s inconvenient and often impossible for many women. That’s why IORT is an increasingly attractive option for qualified candidates.
“For early-stage patients, IORT is a fantastic alternative to whole-breast radiation,” said Nayana Vora, M.D., clinical professor in City of Hope’s Department of Radiation Oncology. “With IORT, there’s less danger of exposing the heart, lungs and ribs to radiation. And there’s no need to come in for a minimum 21 treatments, usually five days a week.”
Walter’s experience is quite typical, Vora said. “Patients usually go home the same day after the lumpectomy and IORT, and they experience very little pain.”
Studies have found that IORT is quite effective compared with whole-breast treatment. The two most cited studies, TARGIT-A and ELIOT, found the five-year recurrence rate for IORT patients was just 3.3 percent — slightly higher than traditional treatment and well within the margin of error — but the overall survival rate for IORT patients was better overall, Vora said. Moreover, the studies confirmed IORT patients experienced far fewer skin complications.
Some observers feel that longer-term research involving larger numbers of patients would be required to get a clearer picture of IORT’s effectiveness — and such studies are inevitable now that thousands of people worldwide have had the procedure, Vora said. 

Straightforward and Streamlined

Nayana Vora Nayana L. Vora
Still relatively new and not available in some parts of the country, IORT is an increasingly pervasive option for patients at City of Hope, which has the most advanced equipment and a highly skilled, experienced staff. 
It’s a very straightforward and streamlined procedure: After the breast tumor is removed, the surgeon places a specially designed balloon inside the incision and fills it with fluid. 
“The balloon expands to create room, and a catheter is inserted to deliver the radiation directly to the spot where the tumor existed, the spot most likely to experience a recurrence,” Vora said.  “We sometimes shield the heart from the radiation, but it’s usually not necessary.”
And that’s that. Fifteen minutes or so afterward, the catheter is removed and the patient goes into recovery. When the doctor feels the patient is ready, it’s time to go home. 
Vora and the team at City of Hope screen thoroughly to determine which patients are IORT candidates — a very important part of the process, Vora said. After initial biopsy, X-rays and a consult, Walter had an MRI to make sure there were no other lesions involved. And prior to the lumpectomy, a biopsy was performed on a lymph node under her arm, to confirm that cancer cells hadn’t spread.  
Today, Walter is enjoying life like never before, babysitting neighborhood children and tending to her garden, a favorite hobby.
“I would absolutely recommend intraoperative radiation therapy to any qualified candidate,” she said. “I wish I could talk to people who are afraid and let them know they can have an experience just like mine. Now every day spent is special to me. The most important thing was getting that first mammogram.”       
For more information about an ongoing IORT clinical trial at City of Hope, click here.

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