Precision Breast IORT (intraoperative radiation for breast cancer) offers an image guided radiation treatment option for women with early stage breast cancer who apply for and are accepted into the study. With this unique form of IORT, subjects receive concentrated radiation at the time of their lumpectomy combining multiple procedures into a single visit.
Listen as Shayna Showalter, MD discusses Precision Breast IORT, a clinical trial option for women with early-stage breast cancer.
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Precision Breast IORT
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Following her surgical training Dr. Showalter returned to the University of Virginia as an Assistant Professor of Surgery in the Division of Surgical Oncology. Dr. Showalter now specializes in treating breast cancer and diseases of the breast. She lives in Charlottesville with her husband and three children.
Learn more about Shayna Showalter, MD
Shayna Showalter, MD
Shayna Showalter, MD is a Virginia native. She grew up in northern Virginia and attended college and medical school at the University of Virginia. She then moved to Philadelphia where she completed her general surgery residency at Thomas Jefferson University and her Breast Surgical Oncology fellowship at the University of Pennsylvania. During her time at the University of Pennsylvania, Dr. Showalter also completed coursework for a certificate in clinical research in the Center for Clinical Epidemiology and Biostatistics.Following her surgical training Dr. Showalter returned to the University of Virginia as an Assistant Professor of Surgery in the Division of Surgical Oncology. Dr. Showalter now specializes in treating breast cancer and diseases of the breast. She lives in Charlottesville with her husband and three children.
Learn more about Shayna Showalter, MD
Transcription:
Precision Breast IORT
Melanie Cole (Host): Precision breast IORT intra-operative radiation for breast cancer offers an image guided radiation treatment for options for women with early stage breast cancer who apply for and are accepted into the study. My guest today is Dr. Shana Showalter. She's an Assistant Professor of Surgery in the Division of Surgical Oncology at UVA Cancer Center. Welcome to the show, Dr. Showalter. How does Precision Breast IORT work? What is it?
Dr. Shana Showalter (Guest): Great. Thank you for having me. Precision Breast IORT is a treatment option for women with early stage breast cancer and what IORT stands for is “intra operative radiation therapy”. To understand how it works, I think it's easier to take a step back. Traditionally, when women choose to have a lumpectomy for the treatment of their breast cancer, it's followed by about six weeks of daily radiation treatment. IORT is a way to decrease those six weeks into one radiation dose that's given at the time of the patient's breast surgery. So, it's getting six weeks down to one day all in the same time of the surgery. Other facilities have forms of IORT but at the University of Virginia, we developed a precision breast IORT which is completely unique. It combines CT Scan imaging’s that are done while the patient's asleep and high dose rate brachytherapy so that we're able to give the patients a very individualized and high dose of radiation all at the time of their breast surgery.
Melanie: Who would consider this as an option? Who would be somebody that would look into this?
Dr. Showalter: In terms of it, this treatment option is part of a clinical trial here at UVA, mainly because we want to have the ability to follow these women long-term to see in the long term how efficacious this treatment option is compared to whole breast radiation. In the short term, we have found that it is safe and feasible and without any major side effects. So, who we consider it is women who have early stage breast cancer, meaning their cancers are 3 cm in size or less, and they don't have any disease in their lymph nodes, so that the cancer has not yet spread to the lymph nodes and that are all age 45 and older. It really does fit a large cohort of our population in terms of women with early stage breast cancer.
Melanie: Speak a little bit about some of the potential benefits and you mentioned that it's all done at one time, so is this too much radiation for people? What are the side effects like and what are the benefits of it?
Dr. Showalter: Yes. That's a great question. One of the main benefits is patient convenience. For a lot of our patients, they physically aren't able because of where they live, or jobs, or children, or child care to come to the hospital every day for traditional radiation, so this is done all at one time. So, one of the main benefits is patient convenience. One of the others is that we are able, with our CAT scan machine and working with the radiation oncologist and the physicists who plan the radiation treatments, to really give a patient an individualized treatment. Whereas, traditional radiation, the most simple way to think of it is it's coming from the outside in, so the patients that have traditional whole breast radiation oftentimes will have a very significant skin burn and will have radiation to parts of the body that we don't necessarily intend to treat, meaning the skin, normal breast tissue, the heart and the lungs. With Precision Breast IORT, we are able to completely sculpt to the dose away from the skin, the heart, the ribs, and the lungs so that patients get the area of the breast treated that needs to be treated but have essentially no radiation to those normal tissue structures. Then, to answer your second question, “Is it too much radiation at one time,” and the answer to that is "No". Prior to doing this current study that we have opened, we did what we call a Phase One study. In that study, we treated 28 patients and none of those patients had any significant side effects to the amount in dose of radiation that we give.
Melanie: How do you know you're hitting the mark? Speak about that ability to be more precise with this type of treatment?
Dr. Showalter: When we do our treatment, we're working in the brachytherapy suite which is a very unique room in the basement of the Emily Couric Cancer Center which looks very much like an operating room but it has a CT scan that's on rails. The CT scanner can literally move. The procedure starts with myself or one of my colleagues performing a breast lumpectomy and then placing a radiation catheter into the area where we removed the cancer. We then get a CAT scan image and what that image does is it verifies that we're in the correct place in terms of putting the balloon where the cancer had previously been and then it also allows the radiation oncologist to use that CAT scan imaging and really sculpt the dose to the area of the breast tissue that needs to be treated while sculpting it away from the areas that don't need to be treated, which primarily is healthy breast tissue, skin, lungs and the heart.
Melanie: Absolutely fascinating and does this kill the tumor cells immediately or does it take some time?
Dr. Showalter: We think about radiation as killing any microscopic disease immediately that was left behind that might not have been cleared during surgery.
Melanie: What about recovery for the patient? What's that like?
Dr. Showalter: The recovery is pretty phenomenal actually. The biggest complaint the patients have is just feeling tired because it is an operative procedure where they're under general anesthesia but there's very minimal pain involved. It's an outpatient procedure, so patients come in and all in the same day they have their breast cancer removed and their radiation treatment completed with very minimal pain. I often have patients tell me that they don't even fill the prescription from the pain medication that we give them. In terms of follow up, the follow up the same as with any of our patients with breast cancer. We, as the surgeons, see them at routine intervals as do the medical and radiation oncologists, and patients will still get yearly imaging to make sure that we catch any potential breast cancer recurrences.
Melanie: What about the rest of the body? If this radiation is delivered through a catheter directly into the former tumor site, then the rest of the body is out of the picture as it were?
Dr. Showalter: Completely out of the picture, yes. And, that's one of the best benefits of this. We have shown that the radiation dose to any other parts of the body other than the area where the cancer was removed and the 1 cm breast tissue nearby that needs to be treated, the radiation dose to other parts of the body is essentially zero.
Melanie: This is in clinical trial phase as of now, Dr. Showalter. What do you see happening in your opinion with this in the future?
Dr. Showalter: We are right now doing a Phase Two clinical trial to look at the long-term efficacy of this treatment option. We are basically a little under half way through this trial. We actually recently, I think just last week, treated our 100 and 101st patient which was exciting on that day. So, we're going to keep plugging away and treating as many patients as we can. We're hopeful that once we have more long-term data that we could potentially spread this to other institutions because while it's exciting to be doing something where we are the one and only, at some point I want this to be a treatment option that's available for patients, not only in Virginia or Northern Virginia where our patients are coming from.
Melanie: How would patients get involved? Is it too late to get involved in this trial or can they still get involved?
Dr. Showalter: No, not at all. The patients that would come to see us would get involved because we would inform the patients of this as a treatment option but we are also more than happy to see patients that have a recent breast care diagnosis that are being seen at other facilities and all they need to do is contact our offices and we can very quickly make appointments and get everything that we need. We know that when patients get diagnosed with breast cancer, it's a very anxiety rich time in their lives, and so we have a really nice system and we are able to work pretty efficiently to get patients into our clinics. When I started the program, I was able to hire a clinical nurse coordinator specifically to help make the treatment process as efficient as possible for these patients. We have a wonderful nurse that sees and follows and really gets to know all of the patients and help make that transition very easy.
Melanie: To see if you qualify and to apply you can contact Debbie Romano?
Dr. Showalter: Yes, that's exactly right.
Melanie: She's the dedicated IORT care coordinator at 434-924-9725. Dr. Showalter, in just the last few minutes here wrap it up for us, and what you want people to know about this Precision Breast IORT and the importance of this clinical trial for women with breast cancer.
Dr. Showalter: This is a novel and completely unique treatment option for patients with Stage One breast cancer that we think is a very exciting treatment option that allows patients with early stage breast cancer to complete their surgical and radiation therapy treatments all in one day and it's unique in the sense that it involves both high dose radiation and image guidance so that patients have an individualized, customized radiation treatment.
Melanie: Thank you so much for being with us today, Dr. Showalter. You're listening to UVA Health Systems Radio. For more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.
Precision Breast IORT
Melanie Cole (Host): Precision breast IORT intra-operative radiation for breast cancer offers an image guided radiation treatment for options for women with early stage breast cancer who apply for and are accepted into the study. My guest today is Dr. Shana Showalter. She's an Assistant Professor of Surgery in the Division of Surgical Oncology at UVA Cancer Center. Welcome to the show, Dr. Showalter. How does Precision Breast IORT work? What is it?
Dr. Shana Showalter (Guest): Great. Thank you for having me. Precision Breast IORT is a treatment option for women with early stage breast cancer and what IORT stands for is “intra operative radiation therapy”. To understand how it works, I think it's easier to take a step back. Traditionally, when women choose to have a lumpectomy for the treatment of their breast cancer, it's followed by about six weeks of daily radiation treatment. IORT is a way to decrease those six weeks into one radiation dose that's given at the time of the patient's breast surgery. So, it's getting six weeks down to one day all in the same time of the surgery. Other facilities have forms of IORT but at the University of Virginia, we developed a precision breast IORT which is completely unique. It combines CT Scan imaging’s that are done while the patient's asleep and high dose rate brachytherapy so that we're able to give the patients a very individualized and high dose of radiation all at the time of their breast surgery.
Melanie: Who would consider this as an option? Who would be somebody that would look into this?
Dr. Showalter: In terms of it, this treatment option is part of a clinical trial here at UVA, mainly because we want to have the ability to follow these women long-term to see in the long term how efficacious this treatment option is compared to whole breast radiation. In the short term, we have found that it is safe and feasible and without any major side effects. So, who we consider it is women who have early stage breast cancer, meaning their cancers are 3 cm in size or less, and they don't have any disease in their lymph nodes, so that the cancer has not yet spread to the lymph nodes and that are all age 45 and older. It really does fit a large cohort of our population in terms of women with early stage breast cancer.
Melanie: Speak a little bit about some of the potential benefits and you mentioned that it's all done at one time, so is this too much radiation for people? What are the side effects like and what are the benefits of it?
Dr. Showalter: Yes. That's a great question. One of the main benefits is patient convenience. For a lot of our patients, they physically aren't able because of where they live, or jobs, or children, or child care to come to the hospital every day for traditional radiation, so this is done all at one time. So, one of the main benefits is patient convenience. One of the others is that we are able, with our CAT scan machine and working with the radiation oncologist and the physicists who plan the radiation treatments, to really give a patient an individualized treatment. Whereas, traditional radiation, the most simple way to think of it is it's coming from the outside in, so the patients that have traditional whole breast radiation oftentimes will have a very significant skin burn and will have radiation to parts of the body that we don't necessarily intend to treat, meaning the skin, normal breast tissue, the heart and the lungs. With Precision Breast IORT, we are able to completely sculpt to the dose away from the skin, the heart, the ribs, and the lungs so that patients get the area of the breast treated that needs to be treated but have essentially no radiation to those normal tissue structures. Then, to answer your second question, “Is it too much radiation at one time,” and the answer to that is "No". Prior to doing this current study that we have opened, we did what we call a Phase One study. In that study, we treated 28 patients and none of those patients had any significant side effects to the amount in dose of radiation that we give.
Melanie: How do you know you're hitting the mark? Speak about that ability to be more precise with this type of treatment?
Dr. Showalter: When we do our treatment, we're working in the brachytherapy suite which is a very unique room in the basement of the Emily Couric Cancer Center which looks very much like an operating room but it has a CT scan that's on rails. The CT scanner can literally move. The procedure starts with myself or one of my colleagues performing a breast lumpectomy and then placing a radiation catheter into the area where we removed the cancer. We then get a CAT scan image and what that image does is it verifies that we're in the correct place in terms of putting the balloon where the cancer had previously been and then it also allows the radiation oncologist to use that CAT scan imaging and really sculpt the dose to the area of the breast tissue that needs to be treated while sculpting it away from the areas that don't need to be treated, which primarily is healthy breast tissue, skin, lungs and the heart.
Melanie: Absolutely fascinating and does this kill the tumor cells immediately or does it take some time?
Dr. Showalter: We think about radiation as killing any microscopic disease immediately that was left behind that might not have been cleared during surgery.
Melanie: What about recovery for the patient? What's that like?
Dr. Showalter: The recovery is pretty phenomenal actually. The biggest complaint the patients have is just feeling tired because it is an operative procedure where they're under general anesthesia but there's very minimal pain involved. It's an outpatient procedure, so patients come in and all in the same day they have their breast cancer removed and their radiation treatment completed with very minimal pain. I often have patients tell me that they don't even fill the prescription from the pain medication that we give them. In terms of follow up, the follow up the same as with any of our patients with breast cancer. We, as the surgeons, see them at routine intervals as do the medical and radiation oncologists, and patients will still get yearly imaging to make sure that we catch any potential breast cancer recurrences.
Melanie: What about the rest of the body? If this radiation is delivered through a catheter directly into the former tumor site, then the rest of the body is out of the picture as it were?
Dr. Showalter: Completely out of the picture, yes. And, that's one of the best benefits of this. We have shown that the radiation dose to any other parts of the body other than the area where the cancer was removed and the 1 cm breast tissue nearby that needs to be treated, the radiation dose to other parts of the body is essentially zero.
Melanie: This is in clinical trial phase as of now, Dr. Showalter. What do you see happening in your opinion with this in the future?
Dr. Showalter: We are right now doing a Phase Two clinical trial to look at the long-term efficacy of this treatment option. We are basically a little under half way through this trial. We actually recently, I think just last week, treated our 100 and 101st patient which was exciting on that day. So, we're going to keep plugging away and treating as many patients as we can. We're hopeful that once we have more long-term data that we could potentially spread this to other institutions because while it's exciting to be doing something where we are the one and only, at some point I want this to be a treatment option that's available for patients, not only in Virginia or Northern Virginia where our patients are coming from.
Melanie: How would patients get involved? Is it too late to get involved in this trial or can they still get involved?
Dr. Showalter: No, not at all. The patients that would come to see us would get involved because we would inform the patients of this as a treatment option but we are also more than happy to see patients that have a recent breast care diagnosis that are being seen at other facilities and all they need to do is contact our offices and we can very quickly make appointments and get everything that we need. We know that when patients get diagnosed with breast cancer, it's a very anxiety rich time in their lives, and so we have a really nice system and we are able to work pretty efficiently to get patients into our clinics. When I started the program, I was able to hire a clinical nurse coordinator specifically to help make the treatment process as efficient as possible for these patients. We have a wonderful nurse that sees and follows and really gets to know all of the patients and help make that transition very easy.
Melanie: To see if you qualify and to apply you can contact Debbie Romano?
Dr. Showalter: Yes, that's exactly right.
Melanie: She's the dedicated IORT care coordinator at 434-924-9725. Dr. Showalter, in just the last few minutes here wrap it up for us, and what you want people to know about this Precision Breast IORT and the importance of this clinical trial for women with breast cancer.
Dr. Showalter: This is a novel and completely unique treatment option for patients with Stage One breast cancer that we think is a very exciting treatment option that allows patients with early stage breast cancer to complete their surgical and radiation therapy treatments all in one day and it's unique in the sense that it involves both high dose radiation and image guidance so that patients have an individualized, customized radiation treatment.
Melanie: Thank you so much for being with us today, Dr. Showalter. You're listening to UVA Health Systems Radio. For more information you can go to www.uvahealth.com. That's www.uvahealth.com. This is Melanie Cole. Thanks so much for listening.