Innovative Radiation Techniques in the Management of Breast Cancer

1) Prone breast irradiation: 

Innovative Cancer Institute (ICI) in South Miami, Florida launches program of radiotherapy of breast cancer in the prone position, to better protect the heart and lungs of the patients during treatment with external beam radiation therapy (EBRT).

The majority of patients with early-stage breast cancer are candidates for breast-conservation therapy, which means minimal surgery to remove the small breast tumor, followed by post-operative radiation of the whole breast, which has been proven to decrease the chance of recurrence of the tumor. Conventionally, this radiation treatment has been done with the patient lying in the supine (face-up) position on the radiation treatment table. Unfortunately this technique has limitations due to the proximity to the heart and lungs and normal skin folds that are in the area of the breast.  Increased radiation related toxicity and worse cosmetic outcome were found in patients with large breasts and large size.  In particular, irradiation in women with large and/or pendulous breasts is a challenge for radiation oncologists. Radiation factors identified as a potential cause of toxicity include increased dose in certain areas of the breast such as the infra-mammary folds, where there is increased skin-on-skin contact. In addition, patients may receive increased doses to critical structures such as the heart or lungs due to the positioning of the breast on the chest wall when the patient lies on her back.  However, research has shown that treating the patient in the prone position (lying face down) can substantially limit the radiation dose received by the heart, lung and skin. A recent study at the New York University School of Medicine found that the prone position was optimal to protect the heart and lungs in all cases of right breast cancer, and in 85% of patients with left breast cancer.

Prone breast irradiation: 

It is a technique that aims to improve some of the technical limitations of the conventional supine position in patients with large and pendulous breasts and at the same time protects lung and heart. This technique also delivers less radiation to the skin reducing less skin changes when patients are treated in the prone position. At Innovative Cancer Institute we are able to use this technique with a specially designed treatment table that is comfortable and easy to reproduce as seen in the picture below.  This new technique uses an innovative ergonomic Q-Fix device placed on top of the couch, which allows accurate placement of the patient face down, with the affected breast hanging freely from the body. The top of the couch is contoured and padded for patient’s comfort, and incorporates adjustable headrests. Indexing features help the doctor place the patient in a very precise way, with the assistance of lasers, so that is in the same position for each of their treatments.

We are pleased to offer our breast cancer patients this excellent radiation therapy treatment option.  Treatment  in prone position is not appropriate in all cases, particularly for a small group of patients due to their anatomy, small-size breasts and others patients who need treatment of the axillary region and chest wall.

2) Radiosurgery

Radiosurgery is another form of highly focused radiation that treats only the area where the tumor was located and a small safety margin. This technique is used in early breast cancer. It requires highly sophisticated equipment and team.  

Standard radiation therapy for patients with breast cancer desiring breast conservation typically consists of lumpectomy followed by radiation. Radiation can either be delivered to the entire breast or to part of the breast. Whole-breast radiation is typically given daily for 3-6 weeks depending on the dose of radiation and the number of treatments fractionation scheme used. The results for partial-breast irradiation are comparable to results for conventional whole-breast radiation. 

Radiosurgery is emerging as a new modality of treatment for early breast cancer that can be given in a reduced number of treatments usually in 5 or less days of radiation therapy using a highly precise form of radiation. 

Beatriz E. Amendola, MD, FACR, FASTRO, FACRO Radiation Oncologist. Founder and Director Innovative Cancer Institute South Miami

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