Merit Health Woman’s Hospital First in Mississippi to Offer Single-dose Radiation Therapy for Treatment of Breast Cancer

1/22/2021

One-time treatment can eliminate up to six weeks of radiotherapy while reducing exposure to COVID-19

[FLOWOOD, MS – JANUARY, 22, 2021] – Merit Health Woman’s Hospital is the first hospital in Mississippi to offer single-dose intraoperative radiotherapy for qualifying early-stage breast cancer patients. This advanced treatment can completely replace the three- to six-week course of traditional external beam radiation by administering a targeted dose of radiation during the patient’s tumor removal surgery. By completing all necessary treatment in one day, breast cancer patients and healthcare staff alike can benefit from fewer office visits during the pandemic.

“We are proud to be the first in Mississippi to provide such an important treatment for women, particularly during the pandemic when exposure should be minimized. This leading edge, clinically-supported radiotherapy system will allow us to provide our patients with another treatment option in the fight against breast cancer,” said Heather Sistrunk, Chief Executive Officer at Merit Health Woman’s Hospital.

The procedure is called Targeted Intraoperative Radiotherapy, or TARGIT-IORT, which was investigated in a large, international study. Long-term study results published in BMJ last August demonstrated no significant difference in the five-year local recurrence rates or survival rates between this new procedure and traditional external beam radiation. In addition, deaths related to heart disease and other cancers were significantly reduced among women receiving the treatment.1

“Women with early-stage breast cancer who are eligible for the treatment achieve the same benefits of traditional radiation with fewer office visits and fewer side effects than traditional radiation. As a physician I am excited to offer this treatment to eligible early-stage breast cancer patients in our state,” said Phillip Ley, MD, FACS, surgical oncologist at Merit Health Woman’s Hospital.

The treatment may also lessen or even eliminate unnecessary travel during the pandemic. Recent studies show that coronavirus surges last spring and summer adversely affected patients’ willingness to comply with their post-surgical treatment regimens. A study published in Journal of the American Medical Association (JAMA) in August found that the number of patients receiving breast cancer treatment fell 52% during the pandemic.2 A study published in November in BMJ demonstrated that deferring breast cancer treatment by as little as four weeks can increase mortality. 3

“As we are seeing another surge in COVID-19 cases impacting the region, this pioneering technology couldn’t be coming to Merit Health Woman’s Hospital at a better time,” continued Dr. Ley. “We can provide our patients with the same clinical benefits as external radiation without additional unnecessary exposure to COVID-19. This new technology also provides all the radiotherapy treatment that is required while allowing the doctor and patient to comply with local and state regulations that may classify some cancer treatments as elective or non-essential.”

Patients who meet the following criteria may be eligible for the new treatment:

• Age 45 or older
• Invasive ductal cancer of the breast
• Have breast cancer in only one part of the breast
• Have breast cancer treatable with lumpectomy
• Have a tumor that is 3 cm (1.5 inches) or smaller
• Don’t have any signs of cancer in the lymph nodes
• Have stage 1 or early stage 2 breast cancer

References

1. “Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomized clinical trial”, BMJ, August 19, 2020 
2. “Changes in the Number of US Patients with Newly Identified Cancer Before and During the Coronavirus Disease 2019 (COVID-19) Pandemic” JAMA Network Open, August 4, 2020. 
3. “Mortality due to cancer treatment delay: systematic review and meta-analysis”, BMJ, November 04, 2020 

EBRT vs. TARGIT-IORT

External beam radiation therapy (EBRT), sometimes referred to as whole breast radiation therapy, involves treating the entire breast from the outside. Although the radiation therapy is directed to the breast rather than the surrounding tissues, the proximity of the heart, lungs and skin limit the dose of radiation that can be given at any one time. This leads to a prolonged treatment course of three to six weeks following surgery. The TARGIT-IORT treatment administers the radiation dose from inside the breast at the time of surgery, precisely where it is needed. This allows the radiation oncologist to deliver a very targeted, single dose of radiation, thus limiting unnecessary radiation to vital adjacent organs such as the lungs and heart.

TARGIT-A TRIAL

The effectiveness of TARGIT-IORT was investigated in an international study called the TARGIT-A Trial. This was a randomized clinical trial that compared risk-adapted partial breast single dose targeted intraoperative radiotherapy (TARGIT-IORT) to three to six weeks of post-operative whole breast radiotherapy. 2,298 patients from 32 centers in the UK, USA, Europe, Canada and Australia participated, undergoing lumpectomy for early stage invasive ductal breast cancer. At long term follow-up (median 8.6 years, maximum 18.9 years), the clinical trial demonstrated that there was no difference in the long-term survival without local recurrence; survival without a mastectomy; and survival without distant metastatic disease. Survival from breast cancer was also similar among those who were allocated risk-adapted targeted IORT during lumpectomy compared to those allocated multiple weeks of whole breast radiation after lumpectomy. There were 41% fewer deaths from other causes (such as cardiovascular causes and other cancers). The paper was published August 19 in BMJ.

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