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Thursday, 25 June 2015

New Breast Cancer Treatment: IORT

A breast cancer diagnosis is scary enough by itself, and for many patients, making endless trips back to the hospital for radiation therapy adds to the misery. But a new radiation treatment offers convenience and peace of mind to a lot of women.

In her twenties, Beverly Treat was a dancer and physically fit. A cancer diagnosis was the last thing she expected to hear from her doctor.

Treat told Ivanhoe, “I didn't know what he was saying and he got right in my face, 'Beverly you have to listen', and I just couldn't focus."

Beverly had early-stage breast cancer. Doctors thought she would benefit from a new cancer therapy called intraoperative radiation therapy or IORT.

With IORT, the moment a tumor is removed during surgery, a precise concentrated dose of radiation is delivered into the cavity left behind. That’s it. No additional trips for radiation treatment.

Katherine Kopkash, MD, Breast Surgical Oncologist at Rush University Medical Center in Chicago told Ivanhoe, “A young mother with two kids at home who has to go two hours a day for radiation, a lot of times, these patients get through a week or two and they’re like, I can’t, it’s just too hard.”

IORT isn’t for mastectomy patients. There are minimal side effects, but unlike long-term treatment, fatigue isn’t one of them.

Treat explained, “To me it’s a like a new day for women, that’s what it is. It’s like coming out of some kind of dark ages.”

The single-dose treatment is considered just as effective as traditional radiation. Just as important for Beverly, it means less time at the doctor and maybe more time to get back on the dance floor.

Doctors say there’s no radiation risk to other people after that single dose.  A patient could go home and hold a baby, without worrying about passing along radiation.

Contributors to this news report include: Cyndy McGrath, Supervising Producer; Andy Roesgen, Field Producer; Cortni Spearman, Assistant Producer and Jamison Koczan, Editor.

BACKGROUND: There are more than 100 different types of cancer, and every year another 1.5 million cases are diagnosed in America alone. An estimated one in every eight women will be diagnosed with breast cancer in her lifetime. Cancer occurs when there is an overgrowth of cells. In breast cancer, the cells form a malignant tumor that can spread, or metastasize, to other parts of the body. Most people who are diagnosed with breast cancer are women, but men can also be diagnosed with breast cancer. Recent research on breast cancer shows that genetics play a role in diagnosis. Inheriting certain genes could mean you have a higher risk of developing the disease. This genetic link has caused some women who know they inherited a gene, to get mastectomies as preventative measures. A mass or lump in the breast is the most common sign of breast cancer. Swelling or pain in the breast can also be a sign of breast cancer. (Sources: http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics, http://www.webmd.com/breast-cancer/guide/understanding-breast-cancer-basics)

TREATMENT: Radiation, chemotherapy, surgery and hormone therapy are all possible treatments for breast cancer. Some of the most typical treatments include surgery and radiation therapy. Surgery, either a mastectomy or a lumpectomy, is used to get rid of the cancer. A mastectomy is surgery that removes the entire breast. After surgery, many women may also undergo radiation therapy, or radiotherapy. Radiation therapy uses targeted high energy X-rays to kill cancer cells. Radiation is used in order to kill any cancer that might be left in or around the breast after surgery.

(Source: http://www.webmd.com/breast-cancer/guide/breast-cancer-treatment)

NEW TECHNOLOGY: Intraoperative radiation therapy or IORT is able to deliver a concentrated dose of radiation therapy to a tumor during surgery right after the tumor is removed. Unlike traditional radiation therapy which can involve five days of treatment a week for up to six weeks, IORT can be delivered in a single session. Because IORT is delivered as a precise dose of radiation, it is able to preserve more healthy tissue and surrounding critical organs such as the lungs and heart. This therapy can help kill microscopic disease, reduce radiation treatment times, and provide an added boost to radiation. IORT spares patients from having to spend multiple days a week in the hospital receiving radiation treatments.

(Source: http://www.cancercenter.com/breast-cancer/iort/)

FOR MORE INFORMATION ON THIS REPORT, PLEASE CONTACT:
Susan Hurley, RN
312-563-3503
Susan_hurley@rush.edu

If this story or any other Ivanhoe story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Marjorie Bekaert Thomas at mthomas@ivanhoe.com

Katherine Kopkash, M.D., Breast Surgical Oncologist at Rush University Medical Center introduces a new breakthrough treatment for breast cancer patients.
Interview conducted by Ivanhoe Broadcast News in April 2015

IORT has been around for a while. What is it?
Dr. Kopkash: It’s very concentrated radiation, which is delivered during surgery, to the lumpectomy cavity, meaning the area where the tumor was previously located. We are able to deliver very precise radiation during surgery.

How is that different from the way it has always been done?
Dr. Kopkash: The standard is called external beam radiation. That’s when a patient has their breast cancer surgery, they heal up for about a month, and then they start getting their radiation.  Radiation is Monday through Friday, every day, for about six weeks. They have to go to a facility. For some people, their facility is 15 minutes away. For some people, it’s an hour away. So it can take up to two hours of their life, every day, for six weeks.

Who developed this IORT?
Dr. Kopkash:  Intraoperative radiation therapy started being done in the late 90’s in Europe. The European Institute of Oncology was one of the first places that had a big study looking at this technology. Then, there were other modalities that were developed very similarly to one they were using at the European Institute of Oncology. We started using it here in the States about ten years ago. Now we’re part of a national clinical trial looking at this new modality in order to deliver IORT.

Even though it has been around in the U.S. for maybe ten years, it really hasn’t been used in a widespread use.
Dr. Kopkash: No, it’s pretty limited use right now.

When you talk about this new modality here at Rush in particular, what does that mean to the person who doesn’t understand what this is?
Dr. Kopkash: We’re using electron brachytherapy. There are different ways to deliver the radiation during surgery, and the way that we’re doing that here is electron brachytherapy. That allows us to do a very short dose of radiation. The average treatment is just ten to 15 minutes, so it really doesn’t extend the time of surgery by very long. Some of the other ways that IORT is performed takes about 45 minutes to an hour, and if someone is under general anesthesia that can double their anesthesia time. We wanted to use a modality for IORT that has a really quick treatment time.

Explain how that’s great.
Dr. Kopkash: I think quality of life matters for breast cancer. Women in general do very well from breast cancer. We treat pretty much every patient like they’re going to be a survivor. We’re hoping they’re going to be a 10, 20, 30 year survivor. We really need to focus on quality of life for their treatments. We need to make sure that the treatments that we are doing don’t have such a huge adverse effect on their daily routine that they just don’t want to complete their treatment because it takes so much time. A young mother, with two kids at home, who has to be gone two hours a day for radiation, a lot of times these patients get through a week or two and they’re like, “I can’t. You know, it’s too hard.” This allows them to receive their entire local treatment in one visit.

The travel time is a huge point. You mentioned earlier the people that are going to give up on radiation but again for those folks in rural areas?
Dr. Kopkash:  I’ve treated now two patients from Southern Illinois, where their nearest radiation facility would be over an hour away. They literally come up here for this procedure because if not, they were looking at a mastectomy down there. That’s what their surgeons had said, “well if you’re not going to be able to do radiation, you should have a mastectomy.” We think it’s a tragedy for a woman to have a mastectomy that doesn’t need to from the oncologic perspective. We know about 80 percent of breast cancer recurrence happens in the quadrant of the breast where the original breast cancer occurred. Right around the area where that person had their first tumor, that’s where they recur. We’re treating that area in a very strong fashion. We think that when we are able to compare it to patients treated with the standard radiation in a long term fashion, it will show equivalent results. That’s what studies have shown from Europe and also the early 2000s here in our country. They showed that when patients are appropriately selected, they had equivalent disease-free survival and overall survival to patients treated with standard radiation.

Are you still crunching the numbers here at Rush to see if it does do that?
Dr. Kopkash:  We’re part of a national clinical trial, so there are over 50 hospitals and universities that are participating.

When will the trial wrap up?
Dr. Kopkash: Their goals are five year and ten year data, and they’re looking to accrue a thousand patients. They’re well on their way to that. I have a feeling we’ll stop accruing patients probably in about a year, but we’re still treating patients using that same protocol.

Do you think it’s working?
Dr. Kopkash:  We’re very excited about the initial results, and we can look at these studies that have been done before to guide us. We know when we appropriately choose the patients, they do really well. It’s all about choosing the right patients.

For Beverly what has that meant for her specifically?
Dr. Kopkash:  Beverly was a perfect patient for this. She was young and active. She had a screening mammogram that detected a small tumor that had good biology. This is a patient that we know that treating her with surgery, six weeks of radiation, it’s probably more treatment than she needed. Also Beverly’s a very active woman. She wanted to get back to her life, her family and her Zumba right away. For her, this was a great option. She did not want to take six weeks of her life traveling to radiation. For her, this was a perfect option.

Are there any big concepts that I am missing that you haven’t touched on in all this?
Dr. Kopkash: I think the big thing is that this is only done for patients that are getting breast conservation. Patients that are getting a mastectomy: this is not an option for them. This is just patients that are getting a lumpectomy with radiation. About two-thirds to three-quarters of the breast cancer patients in our country today are treated with breast conservation. This is great for a lot of women, and like I said, it’s really important just that we’re picking the patients really carefully and we’re following the American Society of Radiation Oncology guidelines for that. I work with my radiation oncologist very closely to help us select these patients.

How many patients are you currently working on who have had this?
Dr. Kopkash: We have now treated over 30 patients at Rush using IORT.
This is one of those things like, “Wow why didn’t I think about that?”
Dr. Kopkash: It’s a really great option. When you hear about it for the first time, you’re like “What a brilliant idea!”

END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

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