One-off breast cancer treatment should be publicly available
New international research confirms that a single, highly targeted dose of radiotherapy during surgery is just as effective as three weeks of radiotherapy after surgery, for women with low-grade, oestrogen receptor positive cancers.
Radiation therapy is an important part of treatment for women who choose to have breast conserving surgery. Usually, patients will have whole breast radiation therapy, and are treated five days a week for a period lasting three to six weeks, about a month after surgery.
Intraoperative radiation therapy is a new way of delivering this radiation. It only takes one dose, given during surgery, which reduces the amount of time patients have to spend travelling to and from hospital treatments.
In addition, it’s much cheaper than traditional radiation therapy, and because the radiation is highly targeted, it reduces the chance of damage to the heart and lungs.
The TARGIT study is an international trial comparing whole breast radiation therapy (WBRT) with intraoperative radiation therapy (IORT). Published last month, it confirmed that IORT destroys remaining cancer cells just as well as WBRT, with a huge reduction in the time spent in treatment.
IORT is an option for anyone who’s over 45, and whose cancer is oestrogen receptor positive, grade 1 or 2, and hasn’t spread to the lymph nodes. This is about one third of all women diagnosed with breast cancer in New Zealand – about 1000 every year.
This new treatment could be particularly beneficial in New Zealand. Because only six cities have the facilities to perform radiation therapy, many patients need to travel long distances to get this treatment. Some choose to avoid this travel time by opting for a mastectomy rather than breast conserving surgery, which doesn’t require the patient to have radiation therapy afterwards, but is a more extensive surgery with a longer recovery time.
IORT would allow patients living far away from major centres to have their surgery and radiation completed in a single session. They’d be able to choose breast conserving surgery, which can offer a better cosmetic result than mastectomy, knowing that their chances of recurrence are as low as if they had a mastectomy.
“For women living in rural areas, breast conserving surgery isn’t an option, because they don’t have the time to spend travelling back and forth from surgery,” says Erica Whineray Kelly, who offers IORT at her private practice in Auckland. “IORT provides a legitimate option to women who otherwise wouldn’t be able to have breast conserving surgery.”
IORT isn’t yet publicly funded in New Zealand, but the NZBCF believe that the treatment should be made available to breast cancer patients all over the country.
“Attending radiotherapy five days a week, for three weeks or more, puts a huge strain on a patient,” says NZBCF CEO Van Henderson. “A lot have to stop working. Some have to temporarily move away from their support system, at a time when they sorely it. IORT would reduce the strain on patients and their families during a tough time, while also ensuring that patients have as low a risk of recurrence as possible.”
At the moment, it’s up to individual DHBs to decide whether or not to fund IORT for patients. If you’re having breast conserving surgery in the near future, ask your specialist about IORT. The treatment is available through private practices, and it’s covered by all major health insurers, with the exception of Southern Cross.