With the snip of scissors during a ribbon-cutting ceremony Nov. 12 at the UF Cancer & Genetics Research Complex, a new era in the treatment of breast cancer in Florida began.
The ceremony introduced the Intrabeam system at Shands at UF medical center, an intraoperative radiation technology available at fewer than 20 treatment centers nationwide and the only Intrabeam system in the state of Florida. Rep. Debbie Wasserman Schultz, a breast cancer survivor and ardent advocate for women with breast cancer, helped cut the orange, blue and pink ribbon.
The great benefit of Intrabeam irradiation for patients is that it reduces or even eliminates the need for weeks of external radiation treatment following surgery for early stage breast cancers.
“The Intrabeam will dramatically shorten the duration of radiation treatment for many of our patients,” said Stephen Grobmyer, M.D., a UF associate professor of surgery and director of the UF Breast Center. “Radiation therapy that would normally require three to six weeks of treatments can now be accomplished in 20 to 25 minutes during the surgery.”
Twenty years in the making, the Intrabeam system is a mobile irradiation device that can be used in the operating room to deliver precise doses of radiation directly to the tumor site. Because it uses low energy X-rays to deliver the radiation dose, it does not require a specialized, shielded room, as do standard, high-powered radiation technologies. Radiation using Intrabeam is delivered from a rod with a spherical tip, which is placed in the cavity left in the breast tissue following removal of the tumor. The tumor bed is then irradiated for a period of 20 to 30 minutes while the patient is under general anesthesia.
The FDA-approved Intrabeam procedure, known as targeted intraoperative radiotherapy, was shown as effective as whole breast radiotherapy but with fewer complications in a clinical trial known as TARGIT-A, launched in 2000.
“The TARGIT-A trial, which is a randomization of standard radiation compared to a one-time dose in the operative theater using Intrabeam, has demonstrated, after four years follow up, that the two are equivalent in their ability to prevent the breast cancer from coming back in the breast,” said Michael Alvarado, M.D., an assistant professor of surgery at the University of California at San Francisco and TARGIT-A investigator. “Not only is the one-time dose of radiation using Intrabeam just as effective as a full course of external radiation, it is more convenient for the patient and there is less risk involved in terms of damage to the heart, the lungs and the skin.”
Studies have shown that 70 percent of women with invasive breast cancer require radiation therapy to destroy remaining cancer cells. Grobmyer, who is a member of the UF Shands Cancer Center, estimates the majority of patients undergoing lumpectomy, a breast conserving surgery that removes the tumor but leaves healthy breast tissue intact, would be potential candidates for treatment with Intrabeam. With the Intrabeam technology, Grobmyer said many lumpectomy patients at the UF Breast Center will now complete their entire course of radiation during surgery, eliminating the need to undergo weeks of external radiation treatments.
“Studies suggest that the farther a woman lives from a treatment facility, the less likely she will be to receive radiation treatments,” Grobmyer said. “Some women will choose to have a mastectomy rather than breast conserving surgery because they aren’t able to commit to three to six weeks of radiation treatments, either because of physical disability or because they live too far away from the treatment facility. Intrabeam now makes lumpectomy a more viable option for many of these patients.”
While Intrabeam irradiation has been shown to be just as effective as external radiation therapy in preventing the recurrence of cancer at the tumor site, it may have an added cancer killing effect that external radiation can’t offer.
“Surgeons expect most, if not all, of the tumor can be removed, but in some cases microscopic parts of the tumor may remain within the tumor bed or attached to structures such as arteries or nerves that cannot be removed. Even under the best conditions, too often residual disease near the margin of the tumor resection remains,” said Paul Okunieff, M.D., chair of the UF department of radiation oncology and director of the UF Shands Cancer Center. “Historically, we would offer radiation after the patient has had time to heal from surgery, but with the Intrabeam system, with little to no added toxicity, radiation can be immediately delivered to the exactly correct location. Any remaining tumor cells are sterilized and have no time to regrow.”
Okunieff said the Intrabeam system has been proven to be effective in the treatment of brain and breast tumors, and it holds promise for the treatment of many other cancer types where the tumor may be attached to sensitive tissues that cannot be removed, such as in the treatment of head and neck, pancreatic and rectal tumors. Okunieff was one of the researchers who participated in the early design and engineering of the Intrabeam device, and he was the first to use it in patients during clinical trials to treat brain tumors.
A $346,000 grant from the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, helped pay for the technology. The grant was intended to broaden treatment options for Floridians, which will be even further expanded by UF’s participation in ongoing clinical trials of the Intrabeam to explore its effectiveness in treating more advanced and aggressive breast cancers.
“Being involved with studies with Intrabeam is an important part of what we do because it allows us to continually assess and refine the uses of the Intrabeam system,” Grobmyer said. “We’re in the era of personalized cancer therapy, tailored to the type and stage of cancer presented by each patient. The Intrabeam system is an important tool in this effort, and it provides excellent results, reduces side effects, and dramatically shortens the duration of treatment.”