Intra-Operative Radiation Therapy (IORT) is radiation therapy technique in which a targeted dose of radiation is delivered to a cancerous tumor site during surgery after the tumor is removed. IORT delivers up to a two-week dose of radiation within ten to twenty minutes and ideally serves as the only radiation needed for breast cancer tumors <3cm. When coupled with oncoplastic surgery, this means a woman with early stage breast cancer could have her tumor removed, radiation delivered and full reconstruction all in one surgery with no additional surgery or radiation treatments required. This is the ideal, new, all-inclusive surgical and radiological treatment for early stage breast cancer.
Once the tumor has been removed, a balloon filled with water that is attached to a portable radiation machine is placed into the breast where the tumor once was. The radiation beams are emitted though the water filled balloon and will penetrate an additional 1cm beyond the already clear margins achieved during tumor removal. Once the dose has been delivered the balloon is removed and the patient is then handed over to the plastic surgeon who will then perform full reconstruction with the benefit of working with fresh, pliable skin that has not been exposed to radiation.
For women who qualify, IORT can eliminate the typical 5 to 6 weeks of daily radiation treatments which expose skin and nearby organs to radiation, cause fatigue and negatively impact lifestyle with 25 to 30 daily trips to the hospital for treatment. It also eliminates the risk of non-compliance of patients not following through with the complete 5 weeks of treatment.
I was fortunate enough to experience oncoplastic surgery with IORT for stage 2 breast cancer as my treatment option at Hoag Memorial Hospital Presbyterian in Newport Beach, California. My brilliant team consisted of Dr. Melvin Silverstein, the pioneer of oncoplastic surgery, Dr. Nirav Savalia, my plastic surgeon who also specializes oncoplastic breast reconstruction and Dr. Brian Kim, my radiation oncologist. Hoag was the first hospital in the Orange County to offer IORT and ran some of the first clinical trials on tumors <3cm with highly favorable results.
Unfortunately, my post surgical pathology report deemed my tumor to be 4.2cm in size and a floating lymph node in my breast had a 3mm tumor. This technically disqualified me for IORT, but I still benefited from having this “boost” dose at the forefront of radiation treatment, as opposed to it being delivered at the end. I was advised to follow through with 28 treatments of whole breast radiation by all of my doctors. This was a heavy blow to my ideal “one stop shopping treatment”. I embraced their advice, returned to Hoag and turned my 6 weeks in Newport Beach into my “Radiant Summer,” camping at the Newport Dunes and riding my bike to my daily “Radiance” treatments.
If you are diagnosed with early stage breast cancer with a tumor, <3m, I highly encourage you to inquire about Intra-Operative Radiation Therapy with your team of doctors. It is only offered at a few hospitals in the US, but if you seek out a hospital that can also offer you the breast preserving option of oncoplastic surgery, coupled with IORT, you may find it worthy enough to travel for your care like I did.
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Melinda Marie Clark