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Reducing Breast Cancer Treatment to a Single Day

For patients with breast cancer, treatment can often take several weeks.

But UVA Cancer Center is among the first centers in the U.S. to offer a new breast cancer treatment that reduces treatment time to a single day.

Learn more about the this treatment option for early-stage breast cancer.
Reducing Breast Cancer Treatment to a Single Day
Featured Speaker:
Dr.Timothy Showalter
Dr. Timothy Showalter is a radiation oncologist at the UVA Cancer Center. In addition to caring for patients with breast cancer, he also treats children with cancer as well as patients with prostate cancer, digestive cancers and gynecologic cancers.

Organization: UVA Cancer Center

Melanie Cole (Host): For patients with breast cancer, the treatment can often take several weeks. But at UVA Cancer Center, it's among the first centers in the US to offer a new breast cancer treatment that can reduce treatment time to a single day. My guest is Dr. Tim Showalter. He's a radiation oncologist at the UVA Cancer Center. Welcome to this show, Dr. Showalter. Incredible. Tell us about this treatment for breast cancer that can reduce the treatment to a single day. Really?

Dr. Tim Showalter (Guest): Well, thanks for having me. It's very exciting. One of the recent trends in breast cancer care in general is that there has been this development of intra-operative radiation therapy. Rather than having selected patients come in for a six-or-more-week course of daily radiation therapy, we can actually get their treatment done in a single day right at the time of lumpectomy. So when they get their surgery, they also walk out that day having had their radiation therapy.
The very exciting component of the IORT program at the University of Virginia is that we're actually doing it quite differently than other places. We have an image-guided intra-operative radiation therapy approach, where we actually use a different style of treatment and different equipment to deliver the IORT. We can actually visualize what we need to treat and visualize the normal tissues and deliver a highly-conformal image-guided radiation therapy plan, all at the same time as the surgery.

Melanie: How does it work? Is it something different than we've seen with typical radiation therapy?

Dr. Showalter: It is. We actually use a type of radiation treatment that's called high-dose rate brachytherapy. What's unique about the setup at the University of Virginia is that we have, within the brachytherapy procedure room, we have what's called a CT on rails. It's actually a diagnostic, quality CAT scan that can slide across the floor. The surgeons come in here. The anesthesiologist comes in. The surgeons do the surgical procedure, remove the breast tumor, verify that at least in terms of an early assessment that the margins are negative. They're still staring at the lumpectomy cavity. They can easily visualize what they need to treat. They place a brachytherapy catheter in the lumpectomy cavity, which basically looks like a balloon with a tubing attached to it, and they close the lumpectomy cavity.
And then we're able to do a CT image right there. Without moving the patient, we acquire the image. We do detailed radiation treatment planning with that patient's CT scan, with the balloon in place. We connect everything and deliver the treatment. The whole time, the patients are being monitored by the anesthesiologist and the breast surgeon. We're able to get the treatment done in time. When the brachytherapy is finished, the surgeons go in and finish closing the wound, remove the catheter, and the patient's on their way.

Melanie: That's fantastic. What are some of the other advantages to doing this IORT? Shorter treatment time is, obviously, but what about tissues', organs' effect of this?

Dr. Showalter: Well, inter-operative radiation therapy, in general, as an overall trend, is really exciting, both for the convenience factor but also because you have the ability to actually visualize what you need to treat at the time of surgery. It gives us a lot more information and control, and we're treating a smaller amount of tissue. We expose less normal tissues to radiation therapy. That's important because standard forms of radiation can expose significant volumes of the heart, if it's a left-sided breast cancer, or the lungs and ribs as well. What's very exciting about the UVA version is that for most inter-operative radiation therapy approaches, it's being done in an operating room without benefit of imaging or the ability to scalp the dose. So we end up with a radiation treatment plan that looks like a simple sphere, and it's something that we can't control or adjust with a misguided planning or any sort of computer modeling. With our approach, we actually take the tools that we use in other situations for breast cancer care and really distill it down into a brief, hour-long procedure that's done at the time of lumpectomy. We use all of our CT scanning and computer planning. We use the ability to use a radiation source in multiple passageways within the applicators so that we can really carve a specialized and highly-conformal radiation plan for that individual patient.

Melanie: Now, are there some particular groups of breast cancer patients who would most benefit from this treatment?

Dr. Showalter: Yeah. This type of treatment is really only appropriate for women who have a relatively small—so generally less than 3 centimeters—breast cancers that are low grade and considered favorable. Part of the rationale is that we're not treating the entire breast. This isn't for women who have more advanced tumors or who are extremely high risk of recurrence. That would be the case overall for anytime we're using what's called accelerated partial breast radiation, which we're just treating part of the breast, or when we're using inter-operative radiation therapy.

Melanie: Are there any side effects? And what are your outcomes, generally?

Dr. Showalter: Well, this is relatively new program for us. This type of treatment, in terms of the inter-operative radiation therapy, is a brand new program for us. While we have a clinical trial that's helping us keep track of outcomes for this, so far, things have gone well, and we can also look at the data from the clinical trials of the other forms of inter-operative radiation, which don't use image-guided planning but do treat a similar volume of tissue. Those have been very large studies with hundreds of women who have agreed to participate in them, and the outcomes look excellent from those studies. It's considered a safe and effective treatment option, and we think that our version has some additional advantages even beyond that.

Melanie: Well, additional advantages. If the patient has to undergo a mastectomy, or something along those lines, is it going to give them options to make this a little bit less drastic or dramatic, like nipple-sparing surgery, such like that?

Dr. Showalter: We're not sure. Just to be clear, this type of radiation is only added to lumpectomy. So it wouldn't be helpful for women who have chosen to undergo a mastectomy or have a medical reason based on their tumor stage that they're going to undergo mastectomy. We think certainly that when women have a partial breast radiation, in general, the future options are less difficult than if they have their whole breast treated. But that's a very individualized scenario that may vary from patient to patient.

Melanie: It's very exciting. Dr. Showalter, what are you seeing on the horizon for this type of radiation therapy?

Dr. Showalter: Well, UVA's unique, currently in terms of the particular layout of our equipment, and we're very fortunate that we're able to offer this for our patients and to be the leaders in developing this type of inter-operative radiation therapy. I think in the future, the next stage for us is going to be working with our colleagues at other institutions. Once we've gained more experience with this, they try to bring them on board and to do larger scale studies. One of the exciting things from an oncology perspective about this version of breast inter-operative radiation therapy, because we have some added advantages in terms of the technique, you can actually deliver a higher dose than what's delivered in other forms of inter-operative radiation therapy. We think that may be helpful for patients in terms of reducing risk of recurrence. I think our next step, I'd like to see this expand to other centers. And I've heard rumors that other facilities across the country are looking at getting brachytherapy procedure areas set up like this with in-room CT imaging. I think that would be the next step.Moving forward, the other approach is that there are other centers that are currently working on extremely short course brachytherapy for breast cancer that is not done at the time of surgery. I think that our results will help inform those trials and may help those centers move their studies forward and help deliver another convenient alternative for patients.

Melanie: In the last just 20 seconds or so, Dr. Showalter, tell us why patients should consider UVA Cancer Center for their breast cancer treatment.

Dr. Showalter: Well, I think this a great example of UVA really pushing forward all of the shared missions. First and foremost, we're a cutting-edge medical center that serves its community. I think this is an example of a clinical program that lots of us, a very large team of folks, have worked hard on to bring forward. It's an excellent program that uses our most advanced technologies and does something that's convenient and I think beneficial for patients. But it also demonstrates our role as a national leader.

Melanie: Thank you so much for listening to UVA Health System Radio. I'm Melanie Cole. Thanks for listening.