Area patients battling breast cancer will have a new weapon in their arsenal later this summer when Baptist Hospital becomes the first Middle Tennessee facility to offer the INTRABEAM®
system that delivers radiation internally at the site of a lumpectomy immediately after the surgery.
Pat Whitworth, MD, a breast surgeon at Baptist, said the new technology offers “a significant advancement” for some patients whose surgeons recommend radiation follow-up. Traditionally, high-energy radiation would be delivered from an external source. With the INTRABEAM, which features a miniature, electronic X-ray source, a probe with a spherical applicator at the end is inserted in the lumpectomy cavity, and low-energy radiation is delivered for 20 to 30 minutes directly into the breast tissue. For many patients, that may be all the radiation therapy needed.
Whitworth explained that progress against breast cancer happens on two fronts: first, improving the cure rate and, second, using “kinder” treatments. “If we can achieve the same local control and the same survival, but we can do it with less trauma or distress to the patient, that’s a big advance. This is in that category,” he said.
There’s also the convenience factor for patients, Whitworth added. Some radiation therapy regimens require several treatments over a span of weeks. For busy patients, and particularly for those who live many miles from the treatment site, the regimen can be a burden. What’s more, Whitworth said research confirms that the further from a treatment site that patients live, the less likely they are to see their therapy through to its intended end. Thus, one dose delivered at the time of the surgery ensures compliance.
“This is going to be an even friendlier situation if we can give that radiation in one dose during the operation. When they wake up, they’re done,” Whitworth said.
Whole breast radiation therapy from an external source is still the recommended move for high-risk patients, Whitworth stressed. However, for several years, lower-risk patients have been receiving external therapy just on the portion of the breast affected by the cancer. The INTRABEAM offers for many of those women an even lower, concentrated radiation dose.
“The real tricky part is proper patient selection,” he said.
Whitworth talked to Nashville Medical News in May while attending the American Society of Breast Surgeons’ annual meeting in Phoenix. There, physicians were debating whether there’s enough data to support the use of internal low-dose radiation exclusively for some low-risk patients.
Studies comparing whole breast versus partial breast radiation therapy have overwhelmingly supported the partial breast approach. Yet, it was just two years ago when the results of a 10-year clinical trial called TARGIT-A were presented at the annual meeting of the American Society of Clinical Oncology. TARGIT-A compared INTRABEAM therapy to external therapy for the treatment of early breast cancer, and the results were very favorable.
Yet Whitworth said the issue is “particularly contentious” for several reasons, including that long-term results are still years away. “Doctors who think they’re experts love to tell each other we’re wrong and argue,” he quipped. Then he added, “The concern is, has the follow-up been long enough and will these amazing, good results hold up over 10 years? I think most of us who have looked at this data would say that we would expect them to, just because these patients are quite low risk.”
Whitworth is obviously convinced about the INTRABEAM’s benefits, and he believes the therapy offers a welcome alternative for most patients. “Most patients have this lower-risk presentation, especially now in this era where we’re doing a lot of screening and cancers are being found very early,” he said.
Another positive of the INTRABEAM is that it follows medicine’s radiation “rule” of minimum exposure at the lowest dose, Whitworth said. The portable instrument doesn’t require a lead-lined room for use. “You can do this in any operating room,” he said.
About 40 medical facilities in the United States and nearly 200 worldwide are using INTRABEAM, produced by a company called Carl Zeiss Meditec, which has operations in California and Germany. Meditec acquired the INTRABEAM technology in 2004 from Massachusetts-based Photoelectron Corp.