Healthy Choices

New breast cancer treatment can reduce radiation to a single day for some

Dr. Gregory Graves of Sutter Cancer Center used Intrabeam to treat Karen Abbott’s breast cancer.
Dr. Gregory Graves of Sutter Cancer Center used Intrabeam to treat Karen Abbott’s breast cancer. Sutter Health

When Karen Abbott was diagnosed with breast cancer in early 2013, she thought she’d be off her feet for a while. She imagined weeks of pain, discomfort and fatigue from radiation. She planned to ditch her training plan for an upcoming marathon.

What she didn’t know then was that Sutter Cancer Center had recently begun using a new radiation device called Intrabeam. Or that she was eligible for it, and would ultimately undergo just a single day of radiation before moving on to a cancer-free life.

The technique is applied during a lumpectomy, a surgery removing the tumor from the breast. After the tumor is removed, the Intrabeam device applies about 30 minutes of targeted radiation to the tumor site, which reduces the chance of tumor recurrence and minimizes contact with healthy cells, said Dr. Gregory Graves, who was Abbott’s surgeon at Sutter Cancer Center.

Intrabeam is used in more than 50 facilities throughout the United States, including nine in California. Sutter is the only facility using it in Sacramento, according to representatives of the device’s German manufacturer, Carl Zeiss Meditec AG.

The goal of this type of radiation is for women to not have to endure daily radiation treatment in the weeks following surgery, as they would with the more traditional “whole-breast” radiation technique. Abbott, who spoke last week from Switzerland, where she is vacationing with her 83-year-old-mother, was declared cancer-free after her Intrabeam surgery in March 2013 and did not return for more radiation, though she later underwent preventive chemotherapy.

She called the Intrabeam procedure a “one and done,” and said she was back to marathon training just a week after surgery. The 58-year-old completed Sacramento’s “Urban Cow” half marathon last week.

“I expected a lot more drama,” she said. “I expected the whole thing to be worse than what it was. It was way easier to be treated for breast cancer than I ever could have imagined.”

The treatment is available only for early-stage breast cancer patients over 45 with negative lymph nodes. More than 50 percent of Sutter’s breast cancer patients meet that criteria, said Dr. Nitin Rohatgi, medical director of the breast cancer program for Sutter Medical Center. The center has performed about 100 of the procedures since it launched the program three years ago.

In a yet-to-be-published study conducted by the Cleveland Clinic, 19 institutions including Sutter Cancer Center entered data on patients treated with Intrabeam before 2013. After a median follow-up time of 12 months, patients showed a 1.6 percent rate of breast cancer recurrence. Graves said the results are equivalent to those of more traditional radiation therapy, which typically requires several weeks of daily radiation.

Unlike external radiation, which encompasses the breast bone up to the clavicle and can cause heart and chest wall problems, Intrabeam’s radiation spreads only 17 to 20 millimeters from its delivery point, Graves said.

“It’s an excellent option for patients who meet the criteria,” Graves said. “Three weeks is a lot. If you can attain the same results in 30 minutes, it’s great for the patient and it also brings the cost down …. There are very clear benefits.”

Despite the positive findings, some in the breast cancer field are still cautious about the device’s potential to become a standard of care. Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, called Intrabeam “reasonably effective” for patients with small tumors who receive the treatment during surgery.

He noted that the treatment has not been proven “better” than the standard therapy, but may be more convenient for some women. The patient follow-up time for the therapy has been relatively short, so there is still a risk of recurrence further down the line, he said.

When discussing the Intrabeam option with breast cancer patients, doctors should be especially candid about the existing information, Lichtenfeld said. Though the device was introduced about 13 years ago, comprehensive trial results were not published until 2011, making it a relatively new treatment in the field.

“Sometimes we fall in love with technology and we want to believe that it may be different and may be better, and the way to protect against that is to make sure patients are fully informed about what the various trials have shown,” Lichtenfeld said. “At this point in time, I’m usually pretty cautious, but I’m saying if the patient is fully informed and meets the criteria, it’s something that they can consider.”

Sutter Cancer Center is in the midst of acquiring another device to assist Intrabeam. This one, called MarginProbe, helps surgeons better identify the perimeter of the tumor and any cancerous cells surrounding it so that removal can be done in one go. Graves said the device adds only six to eight seconds to the procedure, and has been shown to decrease the likelihood of positive margins, or extending tumor, by about 50 percent. He hopes to have it available for patients by January.

The emphasis on a singular surgery is especially important for women in rural areas, who may have difficulty driving back for radiation every day for multiple weeks, Graves said. Research shows that about 86 percent of Intrabeam patients do not need to return for additional radiation after the initial procedure.

MarginProbe “is another way to make sure the first operation is the best a woman can have,” Graves said. “We’re doing everything we can to minimize the chance that a woman has to undergo a second incision.”

Patients interested in Intrabeam therapy can call Sutter Cancer Center at (916) 454-6913.

Call The Bee’s Sammy Caiola, (916) 321-1636.