Pond R. Kelemen, MD, FACS, Director of Clinical Research with the Ashikari Breast Center at St. John’s Riverside Hospital, discusses the advantages of intraoperative radiotherapy (IORT).
Q. How does IORT work in comparison with other types of breast cancer treatments?
A. The traditional technique for radiation after breast preservation surgery is to schedule three to six-and-a-half weeks of whole breast radiation treatments every day from Monday to Friday, taking weekends off. With IORT, we are able to change that equation entirely.
IORT is given in one dose during the lumpectomy surgery. After the lumpectomy is performed and all margins are adequately sampled, a probe is placed into the cavity and the tissue is tightened around it. Radiation is then administered to the cavity site for approximately 15 to 45 minutes, depending on the cavity size. The probe is then removed and the wound is closed. For a majority of patients, this will be all the radiation they will need. For patients with close or positive margins or those discovered to have axillary node metastasis, we will then perform whole-breast radiation approximately four weeks after surgery.
Q. Who is a candidate for this form of treatment?
A. IORT is best used for women over 50 years old with node-negative breast cancer that is less than 2.5 cm at its largest dimension and whose tumor has been completely resected with adequate margins.
Q. What are the benefits of choosing IORT?
A. IORT has the benefit of providing one radiotherapy session while the patient has her breast surgery, as opposed to multiple sessions with whole-breast radiation. In addition, since IORT treats only the highest-risk breast tissue, it is highly effective against the cancer while still sparing the heart and lungs from exposure to radiation. Also, in rural areas and in countries that are medically underserved — anywhere access to radiation treatment facilities is limited — patients tend to forego breast preservation or lumpectomy surgery due to lack of access. These women can now access breast conservation that is combined with one-dose IORT.
Q. Can you describe the level of training and expertise you and your team have in providing sophisticated treatments for breast cancer?
A. We have been doing IORT for breast cancer since 2000 and were the earliest adopters of the technology in the United States. We participated in the early trials of IORT that showed its effectiveness, and we continue to enroll our IORT patients in national and international studies.
Q. What sets St. John’s Riverside Hospital apart from other facilities in the area also offering breast cancer care?
A. We are a multidisciplinary breast center with one of the first National Accreditation Program for Breast Centers accreditations in the state of New York. We pioneered the use of nipple-sparing mastectomy, as well as one-step implant reconstruction. We incorporate oncoplastic surgery into our breast conservation surgeries, utilizing plastic surgery techniques when reconstructing the breast. In addition to having the longest experience with IORT in the region, we offer state-of-the-art 3D mammography. Our ultrasound expertise is unrivaled. We provide advanced surveillance of high-risk women with breast MRI. We also screen all of our patients for risk of genetic mutations and offer the latest testing for a broad panel of cancer genes.
To learn more, visit riversidehealth.org.