The Dr. Isaac González Martínez Cancer Hospital is the first hospital in Puerto Rico and the Caribbean to have this technique to treat breast cancer.
Dr. Julio Díaz Padilla, together with Dr. Edna Mora, surgeon, oncologist and researcher. Photo: Magazine of Medicine and Public Health. Yolimarian Torres.
“In Puerto Rico, we find many patients who, being candidates to preserve the breast, choose mastectomy because they do not have the resources to receive radiation therapy for several weeks,” said the radiotherapist Julio Díaz Padillawho, along with surgeon Edna Mora Piñero, are the only doctors currently certified in Puerto Rico to perform this procedure.
Intraoperative radiotherapy (IORT) with the Intrabeam® device in selected patients with breast cancer allows short and precise treatment during conservative surgery on the tumor bed in situ.
Breast cancer is the most diagnosed type of cancer in Puerto Rican women and continues to be the main cancer death in this population. Its prevalence is 30% and the Department of Health estimates that 1 in 10 women in Puerto Rico is diagnosed with this disease.
For this reason, the arrival of this new way of administering radiotherapy known as Intrabeam, which is administered to candidate patients to preserve the breast during partial removal surgery. This process saves patients from having to receive external radiation therapy for four to six weeks in a radiation therapy unit.
Review of the surgery by the medical team. Photo: Courtesy of the Isaac Martínez González Cancer Hospital.
“There are different techniques, but the one we are administering in Puerto Rico is different because it uses a sphere that is introduced into the area of the lumpectomy, which is the partial removal of the breast,” indicated the Dr. Edna Moraspecialized surgeon and researcher at the Dr. Isaac González Martínez Cancer Hospital.
Regarding use, he stressed that the sphere has different sizes, allowing different tumor sizes to be addressed. ”In all cases, it is evaluated whether the disease has moved from the breast to the armpit. This information is important so that the oncologist can establish the appropriate systemic therapy. In the cases that we have carried out, the postoperative pain has been minimal”, assured Dr. Mora.
Among the data to be highlighted are:
*Intrabeam intraoperative radiation therapy has been designed for patients with stage 1 and stage 2 invasive and pre-invasive breast cancer.
*The tumor cannot measure more than 3 centimeters in diameter and there must be no palpable nodules in the axillae.
*Patients with implants, previous negative biopsies, or cancer in both breasts may be eligible for treatment.
*On the contrary, patients who have already had external radiotherapy in the breast where they now have another malignancy, as well as patients who have more than one focus of cancer in different areas of the breast or suffer from a collagen disease, are not candidates for this treatment. .
*The procedure cannot be used in men either due to the small size of the male breast.
Dr. Díaz Padilla indicated that in the specific case of patients with heart disease and cancer of the left breast, intraoperative radiotherapy can avoid the possible effect that external radiotherapy could cause to the heart.
“In other cases, approximately two to five percent, the final pathology after receiving treatment in the operating room may indicate that microscopically the edges of the lumpectomy have disease. If that happens, intraoperative radiotherapy would be equivalent to two weeks of external radiotherapy and the treatment will be complemented with four to five weeks of additional radiotherapy”, explained Dr. Díaz Padilla.
Studies support the technique
Long-term studies on this intraoperative radiotherapy with respect to recurrence and patient survival are comparable to the results with external radiotherapy.
Although there are other intraoperative radiotherapy techniques using media such as tubes, comparable studies have shown that Intrabeam has equal results to external radiotherapy from an oncological and cosmetic point of view, while other techniques yield moderately effective oncological results and poor cosmetic results.
Regarding recurrence, Dr. Mora explained that if the patient who receives intraoperative radiation therapy eventually has a new lesion in the same breast, the technique can be applied again and she does not have to receive external radiation therapy. Currently, patients who receive external radiation therapy and develop a recurrence or new lesion must be treated surgically with mastectomy.
What advantages does this procedure bring?
This therapy requires a single dose, unlike external radiation therapy, which requires a large number of doses. Through its single intervention, the disease can be controlled in the long term and avoid the risk of recurrence. As a bonus, the aesthetic result is very good, since what the surgeon does is preserved.
Dr. Julio Díaz highlights that through Intraoperative radiation therapy, “we greatly reduce the radiation dose to the heart in cases of breast cancer in the left breast and reduce the dose to the lungs to 0.”
Likewise, the specialist also explains that one of the advantages is the machine, since having a cylindrical and rigid applicator, “the compliance of the dose, we call the dosimetry, the isodosis and the dose gradient that is given to the patient is practically exact to what is prescribed”, which allows reducing the amount of radiation that the patient receives in her tissues that should not be irradiated.
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