Morning Call (Allentown, PA)
June 23--When a doctor told Margaret Karpin in March that she had breast cancer, she took the bad news in stride.
It was just one more shot to Karpin, who over the years has dealt with obesity, uterine cancer, a thyroid problem, an irregular heartbeat, macular degeneration, diabetes and sleep apnea.
"Don't get me wrong, I was very concerned," the 70-year-old Forks Township woman said. "But I realized it was a process I had to go through."
The process for women like Karpin, whose cancer was detected before it spread throughout her body, usually goes like this: Doctors cut open the breast, remove the tumor and stitch up the breast, and then there's a six-week regimen of radiation, five days a week.
Karpin's doctor, however, was finally able to give her some good news. She was one of the first in the Lehigh Valley eligible for a treatment called intraoperative radiation therapy, or IORT. The process sounds simple enough: The surgery, called a lumpectomy, takes place, but before the breast is sewn up, doctors use a mobile radiotherapy device to deliver a 20- to 30-minute low dosage shot of radiation to the tumor site.
That's it. No further radiation, no six weeks of trips to the doctor's office.
That was a relief to Karpin, who was concerned about the toll that traditional treatment might take. "I have all these problems ... and I really do not want either radiation or chemotherapy," she said. "I've had friends who've had it and it's a very hard road. I didn't think I would survive it."
In fact, Karpin was back at home the same day her tumor was removed. "It was an outpatient procedure, which blew my mind," she said. "I was shocked."
St. Luke's University Health Network is the first hospital in Pennsylvania to use the IORT Intrabeam system.
According to its maker, Carl Zeiss Meditec of Germany, the system differs from traditional radiation therapy systems in that it eliminates the need for a specialized treatment room needed for high-energy radiation sources such as linear accelerators.
Intraoperative treatment is not new; the technique was first shown to work in 1984 in Japan. But it took the development of mobile, low-dose radiation technology to allow doctors to treat a tumor site outside a shielded room in a radiation oncology unit.
Besides eliminating the need for repeat visits for radiation, the direct delivery of radiation to the tumor site reduces the skin burning that women sometimes experience during traditional therapy. Essentially, the 30 minutes of IORT provide the same benefit as radiation to the breast over six weeks of conventional therapy, said St. Luke's surgical oncologist Lee Riley.
Riley, who said he began investigating intraoperative therapies about seven years ago, said it requires physicians to make a "mind-set evolution" after years of recommending lumpectomies followed by radiation. The same was true, he said, when the accepted practice switched from radical mastectomies for all breast cancers.
The Intrabeam device received approval from the U.S. Food and Drug Administration in 1999. The treatment for early-stage breast cancer didn't begin to take off until an international trial using the device reported results in 2010. The study showed that breast cancer patients using IORT had no higher rate of recurrence than those receiving conventional treatment.
Not everyone is convinced the trial proved that IORT is just as effective, however. Dr. Benjamin Smith of the M.D. Anderson Cancer Center in Houston has written in a journal of the American Society of Clinical Oncology that the patients in the trial were tracked on average after only two and a half years -- not long enough to know if recurrence would occur.
"I think that trial still reported relatively short follow-up and I have some concerns that some patients may have been lost in that trial," he said. "I think the long-term data showing equivalence ... is lacking. I continue to be intrigued by this treatment, but I'm a little bit cautious in using this in my own practice."
Riley, however, said the trial involved 2,000 women and many were followed longer than the two-and-half year average. Further, St. Luke's is joining other health networks to do more trials, he said.
For now, the treatment is best suited for older women with early-stage breast cancer, he said.
Kathleen Lisella, 83, of Summit Hill, the first woman to undergo the treatment locally, said the option of avoiding daily trips to the doctor for radiation made IORT a no-brainer. When Riley proposed using IORT, "I didn't think twice about it," she said.
Like Karpin, Lisella had a little bit of discomfort from the surgery, but no other noticeable side effects. "I couldn't get over it," Lisella said. "It's like a miracle."
There is one difference between the two patients' experiences, however. Lisella's traditional Medicare covered the treatment but Karpin's HMO did not.
"It's too new," Riley said. "I think that ultimately it will be covered."
Certainly, insurance companies would have an incentive to cover the procedure. Riley said the cost of IORT is $3,000-$4,000, about a third of the cost of traditional radiation therapy.
Riley also said IORT has been tried on other cancers and it's possible that it will become more commonly used on a variety of tumor sites. "We just have to find out where it fits and where it's [of] maximum benefit," Riley said.
For those who've already benefited from the procedure, the results are encouraging.
"I do feel like God held me in the palm of his hand," Karpin said. "I would say I'm back to normal at this point, whatever normal is for me."
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