Intraoperative Radiation Therapy: Simplicity, Speed, Convenience

Estimated reading time: 4 minutes

Over the past decade, advances in breast cancer have been changing women’s lives for the better.

Take breast conservation surgery. Lumpectomy followed by radiation therapy removes only diseased tissue, leaving healthy tissue intact. Yet it delivers a high success rate previously achieved only via mastectomy, total removal of the breast.

Radiation delivered to the site of a tumor has long been acknowledged as one of the most critical defenses against a return of the cancer. And, for many women, Intraoperative Radiation Therapy (IORT)—administered immediately after lumpectomy—is now the fastest, most convenient way to dispense that radiation.

IORT is delivered in a single treatment, in the operating room, right after surgery. While conventional whole-breast radiation requires treatment five days each week for up to seven weeks, IORT takes an average of just 30 minutes, saving the patient multiple post-surgery hospital visits.

Proven in trials worldwide, IORT recently achieved a landmark 18 years of research data—the gold standard for demonstrating a cancer treatment’s safety and effectiveness.

Radiation Post-Lumpectomy

Surgery alone does not deliver the best possible odds of preventing cancer’s return. But a focused dose of X-ray energy can destroy the DNA of cancer cells and stop their replication.

Following lumpectomy, IORT lets us direct the radiation precisely where it needs to be—into the tumor bed, the empty space left behind after the tumor is removed. This is the space in which tumors would be most likely to recur. The treatment is so accurately focused on the tumor site, it gets the job done in just one treatment, at a fraction of the dose typically applied in whole-breast radiation.

Since 2012, MedStar Washington Hospital Center and MedStar Georgetown University Hospital have been the only medical centers in the Washington, D.C. area equipped to offer this valuable therapeutic approach to breast cancer patients. Between the two hospitals, we have completed close to 200 procedures, most of them now included in the U.S. research trial registry. While our full analysis of the procedure’s performance will take some time, we know anecdotally that it has been very effective and has saved hundreds of hours of post-surgical maintenance for women and their families.

For women undergoing lumpectomy, the simplicity, speed and convenience of IORT is a real game-changer.

Simple, Fast, Convenient

An ideal candidate for IORT is typically a woman 50 and over, whose tumor is three centimeters in size (just over an inch) or smaller, non-lobular and both estrogen- and progesterone-positive.

Although whole-breast radiation after surgery can save lives—and is still a recommended approach for some women—it requires a higher dosage and carries a greater risk of side effects, including increased wound contracture, swelling and skin irritation. And treatment cannot be started until three to four weeks after surgery, when the surgery site is relatively healed.

IORT, on the other hand, is performed minutes after surgery, eliminating repeat visits after recovery. Research shows it to be as effective in the appropriate patient population as whole-breast radiation, at less cost. And as mentioned, it can spare the patient the inconvenience of follow-up visits to the hospital several days a week for radiation care.

Lumpectomy with IORT

In the operating room, our lumpectomy patient is put to sleep, and the breast surgery team removes the tumor. Then, the radiation oncology team takes over. They position the IORT machine and calculate the dosage of radiation based on evidence-based guidelines. It is delivered via a smooth, round applicator, placed directly into the tumor bed via the surgeon’s incision.

We protect the skin where radiation can cause irritation and redness, taking careful measurements to ensure the applicator is not too close. Once activated, the machine is left in place for 20–35 minutes, as the patient sleeps. The radiation field is very shallow, so the heart and lungs are never at risk.

Following radiation, we remove the applicator and close the incision in the normal fashion, and the patient is taken to the recovery area. IORT adds no extra recovery time, and unpleasant side effects are rare.

Path to a Cure

Typically, patients consult me after their screening mammogram shows an abnormality. The patient then meets with the breast surgeon, and together we begin our approach to treatment. We take an extensive medical history and evaluate risk factors, family history, mammography and follow-up imaging, and biopsy findings.

If cancer is confirmed, the patient’s information is presented to our multi-disciplinary tumor board, a team of experts working together to determine a unique course of action for each patient.

The board includes eminently qualified surgery, medical oncology, radiation oncology, plastic surgery, rehabilitation, pathology, nutrition and genetic counseling staff, as well as breast surgery and oncology fellows. Many of our board members have been colleagues for decades.

We assign a nurse navigator to communicate the treatment plan to the patient and coordinate consultations and procedures. Depending on the tumor board’s recommendation, the navigator helps the patient get scheduled with the relevant specialists on our team.

By the time surgery is scheduled, the patient has seen everyone she needs to see, and our entire team knows the plan for that patient. We work together to make surgery and continuity of care as efficient and effective as possible, a truly comprehensive, multi-disciplinary effort.

Here at MedStar Washington Hospital Center, our leading-edge medical research gives breast cancer patients access to newly developed treatments.

Don’t Delay Care

Like any cancer diagnosis, time is of the essence when it comes to breast cancer. The later the cancer, the more challenging the diagnosis and treatment, with more procedures and potential side effects. So of course, it’s always preferable to treat early whenever possible.

That’s why your screening mammogram is so important!

And don’t let the pandemic keep you from getting the care you need. We continue to adhere to strict safety and screening protocols regarding COVID-19 to protect patients and staff. Your safety is our top priority.