“New medicines, a multi-disciplinary approach to treatment as well as diagnostic and therapeutic technologies introduced over the last two decades, have significantly improved both the early detection and treatment of breast cancers. These advances are furthermore enabling a highly personalised approach to breast cancer treatment, which is critical in achieving the best possible outcome for each individual patient.”
This is the view of renowned breast disease specialist and specialist surgeon, Professor Carol-Ann Benn, who founded the Netcare Milpark Breast Care Centre of Excellence in association with Netcare some 18 years ago – the first centre of its kind to be established in the private sector in South Africa and the only one in the country which is fully accredited by the National Accreditation Programme for Breast Centres (NAPBC), administered by the American College of Surgeons.
Benn, who heads the centre, was commenting on the introduction of an intra-operative radiation therapy (IORT) service at Netcare Milpark Hospital in Johannesburg. “The state-of-the-art IORT technology is the only equipment of its kind in South Africa. IORT is used to deliver low-energy, highly concentrated radiation to selected patients directly after they have undergone a lumpectomy – a minimally invasive, breast-conserving surgical procedure to remove cancerous lumps – whilst they are still in theatre,” said Benn.
“While IORT has been shown to be as effective as the multiple external beam radiation treatments that have traditionally been used to assist in preventing a recurrence of cancer, IORT has a number of advantages over the latter. These include the fact that IORT therapy is considerably more targeted, is conveniently done immediately after the lumpectomy procedure, and significantly reduces the patient’s exposure to radiation. The introduction of the Zeiss IORT technology and service at the Netcare Milpark Breast Care Centre of Excellence under clinical and radiation oncologist, Dr Yastira Ramdas, is a critical addition to our arsenal in the fight against breast cancer, as well as an important advancement for breast cancer treatment in South Africa,” says Benn.
“While IORT is not appropriate to use in all breast cancer cases, it provides clinicians with an invaluable additional treatment tool and assists the multi-disciplinary team at the centre in developing highly individualised treatment programmes to meet the exacting treatment required for each breast cancer patient,” she adds.
Ramdas says IORT usually takes about 30 to 50 minutes, depending on the size of the tumour involved. An applicator is used to deliver a smaller but highly targeted dose of radiation directly to the tumour bed, the area from which the tumour was surgically removed.
“IORT differs from the traditional whole-breast external beam radiation, which externally radiates the whole breast, or the area of the breast where the cancer is, and is delivered over a number of sessions: typically for five days a week for up to six weeks,” Ramdas said.
“With IORT, on the other hand, the radiation oncologist delivers a large dose of highly targeted radiation in a single treatment session. This assists in reducing side effects, preserving healthy tissue and reducing toxicity to the breast and other organs. The side effects of IORT are usually minimal and may potentially involve bruising and/or a fluid build-up in the breast tissue.”
However, depending on the stage of the cancer, it may sometimes be necessary to follow up IORT with external beam radiation but the duration of the external beam radiation is then reduced.
“It should be noted, however, that the treatment is not appropriate for all breast cancer patients who undergo a lumpectomy. For example, the American Society for Radiation Oncology (ASTRO) stipulates its use only in cases where tumours are less than 3 cm in diameter, and the patient should be 50 years or older.”
“It is the aim of the multi-disciplinary team at the Netcare Milpark Breast Care Centre of Excellence to empower patients with information, to enable them to make more informed choices about their own treatment. When it comes to breast cancer, we customise the treatment to the specific needs of each individual patient, taking into consideration the type and stage of cancer, the patient’s general health status and any co-morbidities, as well as their personal circumstances. Every woman has a unique relationship with her breasts, and we also take that into account,” adds Benn.
The Netcare Milpark Breast Care Centre of Excellence is participating in a collaborative five-year patient trial – known as TARGIT-B – with the Imperial College London. This is a multi-centre randomised controlled trial designed to test whether tumour bed boost delivered by IORT achieves better results than standard external beam radiation.
Patients are currently being recruited for the trial and women who are to have breast-conserving surgery, are 45 years or older, and who have been found to have one or more risk factors for local recurrence, are invited to participate. Women who qualify for the trial and who are interested in participating should contact Ramdas via email on email@example.com.