A relatively new technique could make breast cancer patients post-surgery lives much easier. Intraoperative radiation therapy, or IORT, is a new form of radiation therapy that replaces weeks of traditional radiation therapy. It’s administered in a single dose directly at the tumor site – and given at the same time as the surgery. For most patients, they will not require the normal daily radiation treatments that normally require six to seven weeks. It allows a woman to get her radiation and her surgery in one day.
In this segment, Dr. Veronica Jones shares the latest advances in treatment for breast cancer with our clinical trials of intraoperative radiation therapy and cryoablation, and by having world-renowned scientists, physicians and treatment manufacturing facilities working side by side at our main campus, we’re able to quickly turn breakthrough discoveries into experimental treatments.
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Advances in Local Treatment for Breast Cancer
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Learn more about Veronica C. Jones, MD
Veronica C. Jones, MD
Specializing in breast cancer surgery, the much-honored Veronica C. Jones, MD, joined City of Hope in 2015 after serving as an Assistant Professor of Surgery at Emory University School of Medicine in Atlanta, GA.Learn more about Veronica C. Jones, MD
Transcription:
Advances in Local Treatment for Breast Cancer
Melanie Cole (Host): Physicians and research scientists are on the front lines looking for better ways to care for patients with cancer. Clinical trials are a great way to make scientific advances using the latest technology and resources. A relatively new technique could make breast cancer patients’ post-surgery lives much easier. Intraoperative Radiation Therapy or IORT is a new form of radiation therapy that replaces weeks of traditional radiation therapy. My guest today, is Dr. Veronica Jones. She’s a Breast Surgeon in the Division of Surgical Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Jones. Tell us about some of the exciting advances and localized treatment for breast cancer including IORT.
Dr. Veronica Jones (Guest): Sure. Traditional breast cancer treatment includes breast conservation therapy, which is where we remove a portion of the breast and then traditionally give radiation for up to six weeks after the surgery is performed. It’s every day, Monday through Friday. Intraoperative Radiation Treatment is a newer technique in which radiation is given directly to the surgical bed for anywhere from ten to fifteen minutes during the surgery, and then the patient is done. They do not need to return daily for six-weeks to have radiation therapy. It’s all completed during the surgery.
Melanie: How can that be? Is it a higher level? Is it a higher dose of radiation? How does that work?
Dr. Jones: We actually have found that if a cancer is to come back, it’s most likely to come back right in the area where it originally occurred, and so we discovered that if we give radiation directly to the area where the cancer was, it’s actually as effective as giving radiation to the entire breast. It’s a more concentrated dose of radiation directly where it’s needed most.
Melanie: Tell us a little bit about how the clinical trials were working for IORT and then we’ll talk about Cryoablation and really what that is, but are there still clinical trials or is this now a pretty much standard course of treatment?
Dr. Jones: This is still a clinical trial. There were clinical trials previously done on intraoperative radiation therapy, but there have been newer machines that have come out, and we are testing those machines. This is a clinical trial -- even though previous clinical trials have been done, we are still exploring this area, trying to expand which patients are eligible and following all of the patients long-term because we want to see how these patients are doing ten years from now, twenty years from now. Even the earlier clinical trials that were done are still being followed – those patients are still being followed. It’s not technically standard of care in that we are still learning more and more about this technique as patients progress into survivorship.
Melanie: Speak a little bit about patient selection criteria and who might be a candidate for this particular procedure.
Dr. Jones: Right, so we’re typically looking at patients that have stage one disease, so it’s a very localized disease. We usually like for the span of cancer to be less than two centimeters in size. These are stage one patients who do not have any lymph node involvement. We also primarily look at postmenopausal patients and favorable disease. What I mean by favorable disease, are diseases that are responsive to hormones, what we call estrogen receptor positive disease – diseases that are less likely to come back.
Melanie: So then tell us a little bit about Cryoablation. What is that and how is it different than what you’ve been discussing?
Dr. Jones: Intraoperative Radiation Treatment is radiation that’s given after surgery has been performed. We surgically remove the cancer and then we give radiation to the area where the cancer was. In Cryoablation, we actually do not remove the cancer. We don’t even do surgery. We make a very small incision on the breast, about four millimeters in size, and instead of removing the cancer, we actually just freeze it with a liquid nitrogen gas. That is supposed to kill the cancer cells and stop them from replicating and progressing. We are treating the cancer without a surgery completely.
Melanie: And are there certain candidates for this particular thing too?
Dr. Jones: Yes, so the candidates for this type of procedure are actually pretty similar to the candidates for the Intraoperative Radiation Therapy Treatment. We’re looking for patients who have favorable disease – again, who respond to estrogens, who have less than two centimeters of disease. We also are looking for patients with a certain type of breast cancer. There are typically two main types of breast cancer, invasive ductal cancer, and invasive lobular cancer, and this Cryoablation technique is for the invasive ductal cancers. That just has to do with the way the cancer grows.
Melanie: And with both of these procedures, Dr. Jones, what are you seeing in terms of success rate? Are you noticing that the patients are happier as a result also because it’s more convenient for some of these things and maybe they’re having better outcomes?
Dr. Jones: Right, with intraoperative radiation therapy, the patients are extremely happy. They love their cosmetic results. With traditional radiation therapy that’s given over a course of multiple weeks every day, the patients can get a lot of skin changes, and they notice a sunburn type of appearance to the breast. The breast can also get dramatically larger or smaller than it was previous to the radiation therapy, and they can have chronic pain from the radiation treatment even after the acute side-effects of the skin changes have resolved.
With intraoperative radiation therapy, they do not see the changes that are typically associated with radiation. They may have a little bit of redness, but that typically goes away in a few weeks. They do not have the sunburn changes on the breast. They don’t notice the dramatic change in the size of the breast, and they typically have less pain. All of that is in addition to not having to come to the hospital every day for several weeks. The intraoperative radiation therapy patients are extremely happy with their results.
Melanie: And where do you see this going in the future? Give us a little blueprint for future research, and what you want to tell the listeners they can look forward to down the line.
Dr. Jones: I think that we are getting so much better at treating breast cancer and in the past, we did a lot of surgery for breast cancer treatment. Years and years ago, we actually would remove the whole breast, the muscle, the lymph nodes, everything in the area, and women were left with a significant deformity on the side of the breast cancer. Over time, we have gotten less and less invasive with our treatments. We’re able to do less surgery especially as the medicines that we develop for breast cancer have gotten so good. I think that we are headed toward doing less and less surgery on patients, causing less deformity, and less problems after surgery. I think that this is just part of it – Cryoablation is part of it, Intraoperative Radiation Therapy is part of it. As our medicines get better, as our detection techniques get better, I think we’re going to see less and less surgery being done.
Melanie: What an exciting time to be in the research end of breast cancer. Thank you so much, for being with us today. You’re listening to City of Hope Radio, and for more information, you can go to CityofHope.org, that’s CityofHope.org. This is Melanie Cole. Thanks so much, for listening.
Advances in Local Treatment for Breast Cancer
Melanie Cole (Host): Physicians and research scientists are on the front lines looking for better ways to care for patients with cancer. Clinical trials are a great way to make scientific advances using the latest technology and resources. A relatively new technique could make breast cancer patients’ post-surgery lives much easier. Intraoperative Radiation Therapy or IORT is a new form of radiation therapy that replaces weeks of traditional radiation therapy. My guest today, is Dr. Veronica Jones. She’s a Breast Surgeon in the Division of Surgical Oncology in the Department of Surgery at City of Hope. Welcome to the show, Dr. Jones. Tell us about some of the exciting advances and localized treatment for breast cancer including IORT.
Dr. Veronica Jones (Guest): Sure. Traditional breast cancer treatment includes breast conservation therapy, which is where we remove a portion of the breast and then traditionally give radiation for up to six weeks after the surgery is performed. It’s every day, Monday through Friday. Intraoperative Radiation Treatment is a newer technique in which radiation is given directly to the surgical bed for anywhere from ten to fifteen minutes during the surgery, and then the patient is done. They do not need to return daily for six-weeks to have radiation therapy. It’s all completed during the surgery.
Melanie: How can that be? Is it a higher level? Is it a higher dose of radiation? How does that work?
Dr. Jones: We actually have found that if a cancer is to come back, it’s most likely to come back right in the area where it originally occurred, and so we discovered that if we give radiation directly to the area where the cancer was, it’s actually as effective as giving radiation to the entire breast. It’s a more concentrated dose of radiation directly where it’s needed most.
Melanie: Tell us a little bit about how the clinical trials were working for IORT and then we’ll talk about Cryoablation and really what that is, but are there still clinical trials or is this now a pretty much standard course of treatment?
Dr. Jones: This is still a clinical trial. There were clinical trials previously done on intraoperative radiation therapy, but there have been newer machines that have come out, and we are testing those machines. This is a clinical trial -- even though previous clinical trials have been done, we are still exploring this area, trying to expand which patients are eligible and following all of the patients long-term because we want to see how these patients are doing ten years from now, twenty years from now. Even the earlier clinical trials that were done are still being followed – those patients are still being followed. It’s not technically standard of care in that we are still learning more and more about this technique as patients progress into survivorship.
Melanie: Speak a little bit about patient selection criteria and who might be a candidate for this particular procedure.
Dr. Jones: Right, so we’re typically looking at patients that have stage one disease, so it’s a very localized disease. We usually like for the span of cancer to be less than two centimeters in size. These are stage one patients who do not have any lymph node involvement. We also primarily look at postmenopausal patients and favorable disease. What I mean by favorable disease, are diseases that are responsive to hormones, what we call estrogen receptor positive disease – diseases that are less likely to come back.
Melanie: So then tell us a little bit about Cryoablation. What is that and how is it different than what you’ve been discussing?
Dr. Jones: Intraoperative Radiation Treatment is radiation that’s given after surgery has been performed. We surgically remove the cancer and then we give radiation to the area where the cancer was. In Cryoablation, we actually do not remove the cancer. We don’t even do surgery. We make a very small incision on the breast, about four millimeters in size, and instead of removing the cancer, we actually just freeze it with a liquid nitrogen gas. That is supposed to kill the cancer cells and stop them from replicating and progressing. We are treating the cancer without a surgery completely.
Melanie: And are there certain candidates for this particular thing too?
Dr. Jones: Yes, so the candidates for this type of procedure are actually pretty similar to the candidates for the Intraoperative Radiation Therapy Treatment. We’re looking for patients who have favorable disease – again, who respond to estrogens, who have less than two centimeters of disease. We also are looking for patients with a certain type of breast cancer. There are typically two main types of breast cancer, invasive ductal cancer, and invasive lobular cancer, and this Cryoablation technique is for the invasive ductal cancers. That just has to do with the way the cancer grows.
Melanie: And with both of these procedures, Dr. Jones, what are you seeing in terms of success rate? Are you noticing that the patients are happier as a result also because it’s more convenient for some of these things and maybe they’re having better outcomes?
Dr. Jones: Right, with intraoperative radiation therapy, the patients are extremely happy. They love their cosmetic results. With traditional radiation therapy that’s given over a course of multiple weeks every day, the patients can get a lot of skin changes, and they notice a sunburn type of appearance to the breast. The breast can also get dramatically larger or smaller than it was previous to the radiation therapy, and they can have chronic pain from the radiation treatment even after the acute side-effects of the skin changes have resolved.
With intraoperative radiation therapy, they do not see the changes that are typically associated with radiation. They may have a little bit of redness, but that typically goes away in a few weeks. They do not have the sunburn changes on the breast. They don’t notice the dramatic change in the size of the breast, and they typically have less pain. All of that is in addition to not having to come to the hospital every day for several weeks. The intraoperative radiation therapy patients are extremely happy with their results.
Melanie: And where do you see this going in the future? Give us a little blueprint for future research, and what you want to tell the listeners they can look forward to down the line.
Dr. Jones: I think that we are getting so much better at treating breast cancer and in the past, we did a lot of surgery for breast cancer treatment. Years and years ago, we actually would remove the whole breast, the muscle, the lymph nodes, everything in the area, and women were left with a significant deformity on the side of the breast cancer. Over time, we have gotten less and less invasive with our treatments. We’re able to do less surgery especially as the medicines that we develop for breast cancer have gotten so good. I think that we are headed toward doing less and less surgery on patients, causing less deformity, and less problems after surgery. I think that this is just part of it – Cryoablation is part of it, Intraoperative Radiation Therapy is part of it. As our medicines get better, as our detection techniques get better, I think we’re going to see less and less surgery being done.
Melanie: What an exciting time to be in the research end of breast cancer. Thank you so much, for being with us today. You’re listening to City of Hope Radio, and for more information, you can go to CityofHope.org, that’s CityofHope.org. This is Melanie Cole. Thanks so much, for listening.