Less is more with new breast cancer therapy

When doctors found a cancerous lump in Beverly Mueller’s left breast in 1995, the rural Iowa City woman had a lumpectomy at University of Iowa Hospitals and Clinics, followed by several weeks of daily radiation therapy.

Beverly Mueller
Beverly Mueller enjoys working in her yard.

Mueller, now 79, remembers her breast was tender and uncomfortable throughout those weeks of radiation, and she was often tired.

So when doctors found pre-cancer cells in her right breast in March this year, Mueller was excited to learn about a new procedure that would take away the weeks of radiation and make her recovery go much more smoothly. She had the cells removed and received a high dose of radiation therapy before surgeons finished working.

Doctors at the Holden Comprehensive Cancer Center at the University of Iowa are the first in the state to offer Intra-operative Radiation Therapy (IORT), a treatment that delivers a therapeutic dose of radiation to certain breast cancer patients immediately following their surgery. The procedure is performed in the operating room, which means patients don ‘t have to return for weeks of radiation therapy at a later date.

Sonia Sugg, MD
Sonia Sugg, MD

“This is a huge convenience for patients,” says Sonia Sugg, MD, UI associate professor of surgery. “It saves them the time of having to come back to undergo the radiation therapy for five days a week for up to three to six weeks after they heal from surgery. It advances them that much further along the road to recovery.”

Currently, the standard treatment for early-stage breast cancer is a lumpectomy followed by radiation treatment. However, not all patients who choose a lumpectomy follow through with the recommended course of radiation treatments. Factors like time, money, distance, and access to radiation therapy facilities have caused some breast cancer patients to neglect the radiation part of their treatment plan.
Not completing follow-up radiation can increase the rate of cancer recurrence.

Carol Scott-Conner, MD, PhD
Carol Scott-Conner, MD, PhD

“This will eliminate some of those barriers,” says Carol Scott-Conner, MD, PhD, UI professor of surgery. “In Iowa, where access to treatment facilities can be a barrier, this will help patients complete their treatment plan.”

With IORT, the radiation oncologist is in the operating room with the surgeon. The radiation is delivered following the surgery to the area where the tumor was removed. A large clinical trial confirmed that delivering radiation at the time of a lumpectomy was as effective in preventing breast cancer recurrence as whole breast radiation therapy in selected patients. Besides the convenience of time, IORT also decreases side effects such as red rashes and skin irritations compared to traditional radiation therapy.

Experts caution that IORT is not ideal for all breast cancer patients; it’s currently best used when the cancer is detected early and in patients over the age of 50. The key to being a potential IORT patient is early detection, doctors say. That comes from regular preventive appointments with a gynecologist or primary care physician, visits that will be made available at the University of Iowa Hospitals and Clinics location at Iowa River Landing in Coralville.

“Women who take advantage of preventive care services and who are then diagnosed with breast cancer at an earlier stage may then be candidates for the less-invasive form of treatment, such as a lumpectomy followed by the IORT,” says Scott-Conner, one of four doctors on the hospital’s Breast Cancer Care Program.

“IORT is useful primarily for women with smaller tumors, which means early detection is important,” she says.

For Beverly Mueller, early detection meant a more comfortable recovery.

“I really didn’t have much discomfort following this treatment at all,” she says. “There was a little tenderness but not even enough to take a pain pill. I was able to go back to work right away, I felt fine.”

Breast screenings: Regular mammogram screenings—important for early detection of breast cancer—will be available to patients who choose to receive their care at UI Health Care—Iowa River Landing. When appropriate, Iowa River Landing patients will be referred into specialty services (including IORT) at UI Hospitals and Clinics. To schedule a mammogram, call UI Women’s Health at 319-384-8442 or 800-777-8442, or visit online.

–Winter 2012-13