Radiation Therapy section doesn't talk about IORT

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Mods, the Radiation Therapy section doesn't include information about IORT.

It may be somewhat rare here in the US, but in Europe it's the standard of care for many situations. It should be included.

Moderators

cycle-path, you'll find an article about IORT (intraoperative radiation therapy) in the External Radiation section linked from Types of Radiation in the Radiation Therapy area of the main Breastcancer.org site.

IORT is also discussed in a research article about a January 2011 report from the San Antonio Breast Cancer Symposium: SABCS 'Sandwich' Therapy Touted for Early Breast Cancer (see the Breastcancer.org Says sidebar).

Judith and the Mods

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Mods, I know there is IORT info on the site, but why not talk about it (or at least link to it) on the Internal Radiation page, for example? It seems a little silly to make it part of the External Radiation section, doesn't it?

Further: some of the info on the IORT page is incorrect.

"all the doctors and nurses must leave the room while intraoperative radiation is delivered." Not true, because some IORT is delivered via X-ray and personnel need only be shielded as for a normal X-ray.

"Using intraoperative radiation for internal radiation is very new. Only small studies with short follow-ups have been done so far." Not true -- IORT has been available since 1918.

"Intraoperative internal radiation hasn't been compared to the standard of care: whole-breast radiation after lumpectomy." Untrue.

"It's very expensive to have a radiation machine and proper shielding in an operating room. Most radiation therapy departments are far away from the operating rooms, so the equipment can't be shared or moved." While it's true that it's expensive to have this, it's also not necessary because some IORT machines use Xray only and no shielding is required in the OR. Also, some IORT machines are highly portable.

The article is out of date and appears to have been written by a MO who is opposed to the use of IORT (probably for personal financial reasons). An updated and much less biased article should be provided, but either way there should be links!

Moderators

Hey All, 

Thanks to your suggestions, our editorial team made some changes to the section!! 

http://www.breastcancer.org/treatment/radiation/

Melissa and the Team 

cycle-path

Thanks! This is indeed much better. One correction, still, though: the IORT page says "After the cancer has been removed, a linear accelerator is brought over to the operating table to deliver an electron beam to the area where the cancer was."

IORT can be delivered either as ionizing radiation or X-radiation. If X-radiation is used, there's no linear accelerator. Both Xoft http://www.xoftinc.com/treating_iort.php and Zeiss http://www.meditec.zeiss.com/C1256CAC0038CEFF/ContainerTitel/Intrabeam/$File/healthcare1_2.html have devices that use X-radiation.

Moderators

Thanks. We'll pass that along to our Editors, and get back to you. 

LuvRVing

Another suggestion is to include something about what happens when brachytherapy or IORT fails.  I have had a recurrence after Mammosite last July, and I can find NOTHING that indicates what my radiation therapy can be after I finish chemo.  I can only assume that I can't re-radiate the breast area.  And I am assuming that I can have targeted radiation in the axilla and intermammary gland area.  But it would be nice to address the possibility that brachytherapy occasionally fails, and what treatment will be available should that happen.

Please!

Michelle

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Michelle, I've been told that if you've had PBI from either IORT or a catheter such as Mammosite, you can have another lumpectomy if you have a reoccurance. However, with WBI you must have a MX. I'm not sure about whether you can be re-irradiated.

I think some of this type of info depends too much on the a wide range of factors and that it would be hard to give info about it on BCO. The info here is pretty general, and if you have an in-depth issue you really need to see a doctor. At least, that's my impression. 

Moderators

Okay, more changes have been made: 

http://www.breastcancer.org/treatment/radiation/intraop_expect.jsp

Thanks, 

Melissa and Team 

cycle-path

Melissa, I do appreciate the efforts to improve this section but I really don't understand why your editor is so opposed to stating that IORT can be delivered via X-radiation. The article talks about two methods of delivering radiation, both using radioactive isotopes. Not a word about X-radiation.

The problems of using radioactive isotopes in medicine is of significant concern to the Nuclear Regulatory Commission, which continues to encourage medical technology manufacturers to use X-radiation, rather than ionizing radiation, for medical purposes. http://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html In the future we're going to see much less use of ionizing radiation and much more use of X-radiation in Radiation Oncology. BCO should be "up on" these advances.

Furthermore, it's not true simply that "Doctors don't agree on whether intraoperative radiation therapy is a good alternative to whole-breast radiation after lumpectomy, which is the standard of care." There's a good deal more to the situation than that, and I think your readers might want to know more. 

Here's some good information from another site of the type that could be added to BCO to help women understand the advantages and disadvanges of IORT:

The potential advantages of IORT include delivering of the radiation before tumor cells have a chance to proliferate. Furthermore, tissues under surgical intervention have a rich vascularization, with aerobic metabolism, which makes them more sensitive to the action of the radiation (oxygen effect). Also, the radiation is delivered under direct visualization at the time of surgery. IORT could minimize some potential side effects since skin and the subcutaneous tissue can be displaced during the IORT to decrease dose to these structures, and the spread of irradiation to lung and heart is reduced significantly. IORT eliminates the risk of patients not completing the prescribed course of breast radiotherapy (a well-recognized risk of conventional breast radiotherapy) and allows radiotherapy to be given without delaying administration of chemotherapy or hormonal therapy. IORT has the potential for accurate dose delivery: by permitting delivery of the radiation dose directly to the surgical margins, IORT eliminates the risk of geographical miss in which the prescribed radiation dose is inaccurately and incompletely delivered to the tumor bed. Geographical miss may result from patient movement, inconsistent patient setup, and difficulty identifying the tumor site weeks or months postoperatively and is estimated to occur in up to 70% of patients receiving conventional breast boost radiotherapy. There is potential for decreasing healthcare cost because it is one fraction as opposed to 25 fractions.

With IORT the final pathology reports arrives days post-festum. This has been one of the major criticisms of the technique. So recently a novel handheld probe (Dune Medical Devices, Caesarea, Israel) has been developed for intra-operative detection of positive margins. Such a device can help reduce re-excision rate and improve acceptance of IORT technique.

Women, and many doctors, are fighting for less toxic treatments for BC. IORT is one of those less-toxic treatments, and I feel BCO owes it to their readers to provide full and accurate information about this option. If your editor would like to get in touch with me directly about this subject, I'd be glad to work with him or her. I do not work for or receive any compensation from anyone performing IORT or any manufacturer. I'm just a concerned and informed patient. 

Moderators

Forwarding again to the editors 

new

Hi I am a male 60 years old newly diagnosed with breast cancer.Just wonder if you have any information on using IORT method for male. I read that in cases when breast is small IORT can't be used. Appreciate your prompt responce. Need to decide ASAP on treatment.  

Moderators

In this thread other BCO members have added their opinions and insights to the information that can be found on the site, and you may find some of their posts helpful, although not specifically about male BC. You can also use Search, entering the keyword IORT, to find posts in addition to those in this thread.

On the main Breastcancer.org site there is information at this link:

http://www.breastcancer.org/treatment/radiation/intraop_expect.jsp

Judith and the Mods

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new, the applicators on the IORT machines come in a variety of sizes. It's a little difficult for me to believe that none is small enough to use on a man's breast. Here's a picture of the various applicators for the Zeiss Intrabeam. http://www.targit-research.org/clinics/intrabeam/system-components/

As you'll see in the picture, the smallest applicator is only 1.5 cm in diameter, or about 1/2 inch. It seems to me it would be possible to insert that anywhere and that the relative smallness of the average male breast wouldn't pose a problem.

Perhaps the information you read saying that the applicators were too large to use on a man was outdated.