Done at the same time; Breast surgery and radiation
WEST PALM BEACH, Fla. -- Susan Rosser is not afraid of being a pioneer. Neither is Dr. Beth-Ann Lesnikoski. Together they -- patient and surgeon -- made U.S. medical history earlier this month.
Lesnikoski, along with several radiation colleagues at JFK Medical Center in Atlantis, Florida, performed on Rosser, 51, the country's first-ever breast-cancer treatment with electron intraoperative radiation therapy (e-IORT) that utilizes a particular form of specialized technology.
Think of it as one-stop oncology shopping: a lumpectomy with a (super-sized) side order of preventive electron radiation.
Thanks to the state-of-the-art technology of a multimillion-dollar machine from Sordina Iort Technologies, Rosser received a 45-second dose of powerful, targeted radiation while still on the operating table. The dose, Lesnikoski explains, "was the equivalent of undergoing four weeks of daily external radiation."
What's more, Lesnikoski continues, this form of radiation is far less harmful than standard radiation to patients' skin, ribs, chest muscles, heart and lungs because it is administered while inside the breast -- whose healthy tissue and surrounding organs are protected by an internally placed shield.
Two weeks post-surgery, Rosser says, "I feel great -- and didn't even need any pain medication."
And Lesnikoski reports that the two-hour outpatient procedure "went as well as we could have hoped for."
Good thing, too, considering how much time, effort, expense -- and travel -- went into bringing this cutting-edge treatment to the U.S.
Popular in Europe
Lesnikoski and fellow breast surgeon Dr. Robert Gardner have both long been interested in the radiation techniques that have been standard practice in Europe -- especially Italy -- for the past decade.
So, earlier this year, Lesnikoski, Gardner, radiation oncologist Dr. Georges Hatoum, and radiation physicists Dr. Xiaodong Wu and Dr. Yi Zheng traveled to Milan for a few weeks of intensive training with Italy's leading intraoperative-radiation practitioners.
"The interdisciplinary approach is crucial," says Lesnikoski.
That's because the physicists handle the delicate and exacting calculations -- the "aiming," if you will -- necessary to deliver the electrons precisely where they need to go.
Likewise, radiation oncologist Hatoum -- who also has surgical training -- is responsible for the dosage delivery and duration.
In addition, Hatoum, Wu and Zheng worked extensively with Sordina Iort Technologies to modify the machine so that it met U.S. specifications for building codes and other safety standards.
"JFK Medical Center had to retrofit its facility to accommodate this technology," Lesnikoski notes.
The surgery was actually delayed by a couple of weeks as JFK finalized the building alterations.
‘I want to be your guinea pig!'
While JFK's oncology team was in Europe, Rosser was diagnosed with early stage breast cancer -- a 1-centimeter tumor.
The first surgeon Rosser visited recommended a double mastectomy and reconstruction.
"I felt that was like killing a fly with a sledgehammer," recalls the married Palm Beach Gardens resident, whose 82-year-old mother is a 10-year breast cancer survivor. "I thought, ‘There has to be a less radical solution."'
When Rosser learned that Lesnikoski was preparing to debut the availability of the IORT procedure -- and that she would be an excellent candidate for it -- she says, "I told Dr. Beth, ‘I want to be your guinea pig!"'
According to Lesnikoski, here's what made Rosser so suitable:
n She had a small tumor (4 centimeters or less).
n There was no lymph node involvement (meaning it had yet to spread).
n It was the BCIS form of the disease -- one that is considered highly invasive.
"Susan's pathology indicated her breast could be preserved with ‘oncoplastic' surgery," Lesnikoski explains. "The e-IORT -- which in this case is preventive -- would spare her from the standard six to seven weeks of post-surgical external radiation."
Rosser will probably still need a couple of weeks of external radiation, but says, "That's better than doing it for nearly two months."
Depending on their pathology, many future patients won't need any post-surgical external radiation, Lesnikoski says.
"I envision this treatment being a viable alternative for two groups: busy professional women and elderly ones who have difficulty with transportation."
Other than being relatively new -- and thus void of long-term data -- about the only drawback to this treatment is that it necessitates the surgeon make a bigger incision -- 7 centimeters instead of around 3 -- to accommodate the protective shield. This leaves a bigger scar.
Even so, "My scar is lined up perfectly with my bra line, so I'm fine with it," Rosser says.
As JFK oncology doctors become more proficient with this radiation technology, Lesnikoski envisions it being used for other cancers, including pancreatic, rectal and uterine.
And Lesnikoski stresses that what makes JFK's acquisition of this technology so commendable is that "it will probably end up costing the hospital more money than it makes. But giving suitable patients the option of this treatment was, and is, the right thing to do."
Steve Dorfman writes for The Palm Beach Post.
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