Hi all,
Curious if anyone has undergone intraoperative radiation therapy? I’ve been reading about it via Columbia and just requested a consultation. It’s for patients with masses less than 2 cm, early stage, undergoing lumpectomy. Basically instead of following surgery up with weeks of radiation, they give the exposed area, during surgery, one strong session of it. This apparently spares uninvolved tissue, so less of those nasty radiation side effects. The studies point towards a new standard of care, so I’d love to know if any of y’all have had it?
Thanks as always!
Hi there - I was not aware of interoperative radio, but when I had a lumpectomy and radio during lockdown (Nov '20 and Feb '21) I was pleased to learn from the oncologist that a 10 year research project had shown that the risk/outcomes of just 5 radio sessions were no worse than from 15 sessions. I was lucky enough to be offered the shorter programme and I think this has now been rolled out across the UK. There is a little more radiation at each session but it was quick and easy with no side effects other than extreme fatigue for a few months after it was over. I did Wed, Thurs and Fri one week, a break over the weekend, and Mon and Tues the following week. All very do-able and although my DH drove me to each session, I would have been OK driving myself. Hope this reassures you, and good luck 
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No but it’s interesting . My mass was diagnosed as being 8 mm after a positive biopsy and a failed procedure where some of it was removed 6 mm was removed the second time - so no more than 10 mm and slow growing with no lymph involvement meaning I would have been eligible for this.
I’m thinking there are advantages - there’s a wait for radiotherapy but if it’s done at the same time then there’s no delay . Also less of us needing multiple treatments would mean that the people who do still need those might get it quicker . Maybe less chance of any stray cells escaping if they are zapped at the time instead of waiting and then needing to be mopped up by radiotherapy later .
I had the 5 treatments which although it’s a higher dose per treatment is a lower dose overall but even then if I got a recurrence I don’t think I’m able to have radiotherapy again on the same side . I’m wondering if this new treatment would be focused enough on a smaller area that it might be possible in the future to have radiotherapy again to the same breast if needed.
I imagine the criteria will be very strict . I’m on a medical trial called the SMALL trial - also with very strict criteria and was randomized to have my tumour removed by vacuum assisted excision under local anaesthetic by a Radiologist ( she told me recently that I’m the only patient that it didn’t work for ) . When you have this procedure they don’t take lymph node biopsies so they have to be very sure that your lymph nodes are not affected. In the end I had the lumpectomy and sentinel node biopsy .
I would say find out how long it’s been running for not just in general but in the centre where you want to have it. Although the SMALL trial had been running nationally for a couple of years and regionally for several months I was the first one to be on it in my hospital and it was all a bit disorganized to begin with which greatly added to the stress of the situation. I was initially very upset when it failed as well though I’ve now come to feel that it was for the best .
Obviously you’re in the US but I would imagine that it works the same way there as it does here in that they want you to be well - they are literally invested in you staying healthy. My yearly mammograms have been done in a timely fashion and i got my DEXA scan without any argument about who should request / pay for it. I didn’t wait as long for radiotherapy as some either though that may have been more to do with when my treatment was and the centre I had it done at. There definitely are advantages to be part of a research study / medical trial .
I’d be interested to hear if you’re accepted and how it goes but the best of luck to you 
whatever
Xx .
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Interesting trial! I’m sorry it didn’t work completely for you. It’d be nice if they did develop something a bit less invasive than lumpectomy for smaller tumors.
Im really worried about radiation damaging my skin, so this is part of why I’m looking around at options. I’m extremely pale, and can barely handle UV rays much less this sort. Did the 5 sessions cause any discoloration, blistering, etc?
Yes I think the results from the SMALL trial are promising it’s very similar to how benign lumps are treated . You still need radiotherapy and hormone blockers for 5 years though ( I abandoned Anastrozole but was allowed to stay on the trial because my first procedure failed).
I’m also very fair and I burn easily in the sun and sometimes get prickly heat so I was also worried about radiotherapy but someone on my team said that the colour of your skin doesn’t make a difference . I did have redness heat and a bit of swelling which all took probably about six months to properly settle . Some itching as well which was persistent but has gone now. I had some fatigue which was constant for a couple of weeks then came and went getting less frequent for the next two months.
My skin did not break down or blister though and my breast are now the same colour , the skin texture looks the same as well though I sometimes think the skin feels a bit different on the affected side .
If you have it get your skin in good condition before you start and make you do the post- operative exercises every day and continue for at least three months after . I can’t tell you it’s risk free because it isn’t but I’m glad I had it.
I think there’s always one aspect of treatment which scares us more than the others and for you it’s obviously radiotherapy . For me initially it was general anaesthetic because of an underlying health problem but the surgery and anaesthetic were fine in the end and radiotherapy went at least as well as I had expected. As with everything the reality is different to our apprehensions , the thing that turned out to be the big bad for me in the end was the hormone blocker yet I know many women take them without problems for up to ten years.
It’s great that you are approaching this with an enquiring mind and asking these questions xx
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Just to let y’all know my doc says intraoperative has its own complications - like causing a hard cavity within the breast - so she wouldn’t normally recommend it. They use it a lot with older patients that can’t handle getting to radiation every day. I guess there are no easy shortcuts!
Well at least you asked and know the reasons why - unfortunately almost everything comes with its own set of complications . I did wonder how it might affect wound healing .
It is getting easier - things are changing all the time . Years ago people had 30 radiation treatments then 15 and now often just 5 . Xx
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