Physicians at Scripps Health have become the first in San Diego County to use a unique technology to deliver radiation treatments to breast cancer patients faster and more precisely than conventional methods by administering it to them in the operating room during surgery.
The new electron intraoperative radiation therapy (electron IORT) technology at Scripps uses a mobile linear accelerator to deliver electron beam radiation treatment into the patient’s open surgical site after the tumor is removed. Developed by IntraOp Medical Corporation, the IntraOp Mobetron® technology is housed on the campus of Scripps Memorial Hospital La Jolla. This is the only site in San Diego County to offer this highly advanced technology.
Week’s worth of therapy in one minute
Most breast cancer patients require approximately six weeks of conventional X-ray radiation therapy after breast-conserving surgery (or lumpectomy), but electron IORT can deliver a full week’s worth of radiation in about a minute. This can cut a typical six-week course of post-surgery radiation treatments down to five weeks, a reduction of about 16 percent. This modality also delivers radiation more precisely and effectively to the targeted tissue than conventional external beam radiation, because electron IORT has the benefit of direct visualization of the tumor site, no entry dose, little if any exit dose and a very uniform radiation distribution.
“Electron IORT is a new choice in San Diego County that can benefit our patients in multiple ways,” said Mary Wilde, MD, medical director of the Scripps Polster Breast Care Center at Scripps Memorial Hospital La Jolla. “It is highly targeted, as the surgical oncologist and radiation oncologist can visually pinpoint the optimal site for radiation, which helps avoid irradiating much of the heart, lung and surrounding healthy tissue. It also helps reduce the time and inconvenience of daily radiation treatments, five days a week, for several weeks, which lets patients move forward with their recovery sooner.”
At Scripps, electron IORT initially will serve as a boost dose to a patient’s radiation treatments. In the future, Scripps plans to develop a protocol to deliver all of a breast cancer patient’s required radiation therapy with electron IORT in a single two-minute dose during surgery. This approach would eliminate the need for any post-surgery radiation. Scripps also plans to investigate the possibility of expanding this treatment option to other types of cancer.
Precision translates to better tumor control
According to Dr. Wilde, the precise radiation delivery of electron IORT translates into better tumor control and lower probability of cancer recurrence. The primary candidates for electron IORT are early-stage breast cancer patients who opt for lumpectomy surgery. Candidates are pre-screened for this therapy option by the treating surgeon, with the final determination regarding suitability being made by the radiation oncologist.
Scripps funded the purchase of the $1.4 million electron IORT technology entirely through philanthropy. Treatments at Scripps began in December 2014 and to date 19 patients have been treated with electron IORT.
Many patients are candidates
The American Cancer Society reports that approximately 292,000 new cases of breast cancer will be diagnosed in the United States in 2015. Dr. Wilde, whose practice as a breast cancer surgeon spans more than 20 years, estimates that approximately 70 percent of her breast cancer patients are treated with lumpectomy, and many of them are candidates for electron IORT.
According to IntraOp Medical Corporation, this treatment for breast cancer has been available in Europe for more than 15 years and currently more than 20,000 women in Europe have been treated with electron IORT for breast cancer with excellent results. The electron IORT unit can be rolled into a standard operating room to deliver electron IORT directly to the tumor bed during surgery, immediately after the tumor is removed. Electron IORT delivers a concentrated, precise dose of radiation. Medical studies have demonstrated the safety and effectiveness of electron IORT therapy for breast and other tumor sites.
IntraOp reports that this technology is currently utilized by leading medical institutions such as Mayo Clinic, University of California, San Francisco, Massachusetts General Hospital, Stanford University Medical Center, and dozens of other locations in the United States and worldwide.
The Mobetron unit received Food and Drug Administration approval in 1998. Medicare approved reimbursement for electron IORT in 2013. Electron IORT has an established history of reimbursement by many private health insurance payers.
Cancer care at Scripps
Scripps Health is a nationally recognized leader in cancer care, providing comprehensive care at its five hospital campuses and various Scripps Clinic locations. Scripps treats more cancer patients annually than any other provider in California for the following cancer types: breast, colon, bladder, lung (small-cell carcinoma), Hodgkin lymphoma and non-Hodgkin lymphoma. Scripps ranks in the top five statewide for the number of patients treated annually for cancers of the prostate, pancreas, kidney, lung (non-small cell carcinoma), thyroid and skin (melanoma).
Scripps Cancer Care physicians and staff work collaboratively toward cancer prevention, early detection, coordinated treatment and community support services. Scripps Cancer Care is actively involved in leading-edge clinical, translational and basic research. It is accredited as an integrated network program by the American College of Surgeons’ Commission on Cancer, a distinction that demonstrates consistency in providing the highest quality of patient care.
Scripps offers advanced treatment technologies at the Scripps Proton Therapy Center, the Scripps Radiation Therapy Center and the San Diego Gamma Knife Center, and through its minimally invasive surgical program and CyberKnife stereotactic radiosurgery. Additional resources include specialized breast care centers and infusion clinics, nurse navigators, rehabilitation services, support groups and the Scripps Center for Integrative Medicine.
Learn more about Scripps Health, a nonprofit integrated health system in San Diego, Calif.
- Stephen Carpowich