For women with early-stage breast cancer, many clinicians are now considering a treatment option known as intraoperative radiation therapy (IORT), a procedure that delivers a targeted single dose of radiation at the time of lumpectomy. The technique was developed at the University of College London in 1998 and its use has been expanding in the U.S. in recent years. Celebration Health, for example, has offered IORT with the Xoft® Axxent® Electronic Brachytherapy (eBx®) System® since 2012 and has treated 70 women using this procedure. The Xoft System was FDA cleared in 2006.
IORT allows radiation oncologists and breast cancer surgeons to work together to deliver a full course of radiation treatment in one day to select women diagnosed with early-stage breast cancer. The procedure can significantly reduce radiation exposure and enables most patients to return to their normal daily activities within days rather than weeks.,
How it Works
After a lumpectomy is performed, a flexible balloon applicator is temporarily placed inside the tumor cavity. A radiation oncologist places a miniature x-ray source inside the balloon-shaped catheter, which is used to deliver a single dose of radiation treatment directly to the tumor bed. This targeted dose of radiation kills residual cancerous cells while sparing nearby healthy tissue including tissue in the heart, lungs, and ribs. After the radiation has been delivered, the balloon is deflated and removed, and the patient’s incision is closed. On average, the whole procedure including surgery and IORT treatment is completed within 90 minutes.
Compared to traditional radiation therapy that is administered from outside the body, IORT delivers a full course of targeted radiation from inside the body, directly within the tumor cavity. This radiation adequately penetrates target tissue and also requires minimal external shielding, making it safe for medical personnel to remain in the room during treatment.
The Xoft System can deliver an entire course of radiation in as little as eight minutes, allowing patients who meet specific selection criteria to replace six to eight weeks of traditional radiation therapy with a single dose of radiation therapy. It offers a number of patient benefits, including added convenience, shorter treatment times, and lower costs, as compared to traditional radiation therapy. Traditional breast cancer treatment can present a risk of side effects including fatigue and radiation burns while side effects associated with IORT are generally less severe and can occasionally include redness, dryness, itching, soreness, and/or blistering.iv
It is important to note that not all breast cancer patients are candidates for IORT; for those who are not appropriate candidates, traditional radiation treatment may be the best option. Patients who are candidates for IORT include those with ductal carcinoma in situ (DCIS) or early-stage invasive breast cancers (stage I or II) that have not progressed to the lymph nodes.
A Value-Based Solution
Given the many patient benefits and a growing body of positive clinical data, more than 50 leading healthcare facilities around the globe are now offering the Xoft IORT procedure to patients, with more adopting the technology every year. More than 2,000 patients have been treated with the procedure thus far.
Studies show that, given the choice, patients typically prefer a shorter course of radiation, rather than daily radiation administered for several weeks. Some women, such as those who live in more rural areas, women who are in the workforce, and women who are caretakers for their families, may find it difficult to finish a course of treatment that requires numerous medical office visits. This can cause some women to consider mastectomies to avoid having to travel great distance for daily treatments with radiation therapy.
For eligible patients, IORT has demonstrated that it can be an effective, targeted solution and an important option to consider for many women diagnosed with early-stage breast cancer.
Olga Ivanov, MD, FACS
Dr. Ivanov is a board-certified and fellowship-trained breast surgeon, and serves as the medical director of the Comprehensive Breast Health Center at Celebration Health in Celebration, Florida. She received her medical degree from the Medical College of Ohio, completed her residency in general surgery at Loyola and completed her fellowship training at Northwestern Memorial Hospital in 2005. She brings her innovative breast care program to Celebration Health from Chicago, Illinois, where she served as medical director of the Comprehensive Breast Health Center at Little Company of Mary Hospital.