Single-dose intraoperative radiotherapy (SD-IORT) for early stage breast cancer

Intraoperative radiotherapy (IORT) of the breast is a type of breast radiation administered as a single treatment during surgery, while the patient is still under anaesthesia.

IORT is considered an effective and safer alternative to standard breast radiotherapy, which is usually administered after a lumpectomy on a daily basis for up to five weeks. For many women, IORT makes breast conservation and breast radiotherapy a far more practical and convenient treatment option.

In the operating theatre, the breast surgeon places a specially designed inflatable balloon applicator into the space where the tumour was removed (see diagram), and then delivers the dose of radiation in as little as 10–20 minutes.

IORT delivers radiation inside your breast close to where the tumour was. The goal of radiotherapy is to preserve the healthy tissue and eliminate any remaining cancer cells. Even though breast surgeons make every possible effort to remove all cancerous tissue at the time of surgery, microscopic cancer cells are often difficult to detect and surgically remove.

With IORT, your breast surgeon can deliver the appropriate dose of radiation to the tumour bed in a single dose. When you wake up from your surgery, the tumour has been removed and the area surrounding it has been irradiated. This often means that the patient does not need any additional radiation treatment, although the final decision will depend on your individual circumstances.

Spire Bristol Hospital is the first and only place in the South West to perform this new procedure.

For patients considering the surgery, the tumours must be small (less than 2cm) and low grade cancers which have not spread to the lymph nodes - ideally those detected through mammogram screening.

How does the IORT treatment work?
In the operating theatre, your breast surgeon will place a specially designed inflatable balloon applicator into the space where the tumour was removed. This space is called the tumour bed. Your surgeon can change the size of the balloon by inflating or deflating it until it fits snugly into the tumour bed. After the cancer has been removed a steel plate is placed on the chest wall to prevent damage to the ribs, lungs and heart. The entire dose of radiation is delivered in 10–20 minutes.

Which patients are well suited for IORT?
If you are suitable for a lumpectomy procedure and are 45 years of age or older you might be eligible for IORT. It will also depend on what stage your breast cancer is – this treatment is best suited for early stage breast cancer that is oestrogen-receptor positive. Other factors, such as the size of your tumour, are also important. IORT is suitable for tumours of 3cm or less.

What are the possible side effects of IORT?
You usually experience fewer side effects after IORT compared to other types of breast radiation because less of the breast is being treated. Some patients suffer a mild tenderness or discomfort after they wake up from their lumpectomy. Early side effects can include redness of the skin over the surgical site, dryness, and itching, which go away after a few weeks. Some women have bruising and swelling around the site. There will probably be a small amount of drainage from the area where your surgeon inserted the balloon. A small number of patients can have fluid build-up, bleeding, infection or a delay in wound healing where the applicator was inserted.

Because the surgery and the radiation therapy can be done at the same time, many patients prefer IORT. Many patients are comforted knowing that they don’t have to wait for their radiation treatment to begin at a later date. Many also appreciate being able to return to their usual living routines more quickly because of the simple convenience.

What are the benefits of having IORT for breast cancer?

  • Shorter treatment times: Because IORT is a single targeted dose on one day, patients can usually return to normal life routines more easily. There isn’t the disruption to family and work life of travelling to and from the hospital daily for many weeks. In most cases, only one radiation treatment is necessary.
  • Speed of treatment: In early stage breast cancer, IORT delivers a concentrated dose of radiation to a tumour site immediately after the tumour is removed. This immediate treatment helps to destroy microscopic and undetectable cancer cells that may remain despite the surgeon’s best efforts to remove every last bit of cancer.
  • Clinical research shows that the immediate tumour site is often at high risk of recurrence and traditional breast cancer radiation therapy requires a recovery period after lumpectomy surgery, which potentially leaves microscopic untreated disease in this area for some time.
  • Spares healthy tissues: During breast IORT, a very precise radiation dose is applied while protecting healthy tissue with an internal shield. Normal tissues and critical organs such as the heart, lungs and ribs can be spared from receiving radiation.

Advantages of SD-IORT

  • Only one radiation treatment needed
  • Less patient travel, fewer hospital appointments
  • Fewer side effects
  • Better cosmetic results
  • Immediate reconstruction can be done right away
  • Faster recovery time for patients

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