Magic ball that spares breast can­cer pa­tients gru­elling weeks of radiotherapy

Daily Mail - - Good Health -

RADIOTHERAPY given dur­ing breast can­cer surgery has just been ap­proved by NICE. Lynn Ash­man, 59, a for­mer mar­ket­ing di­rec­tor from Malmes­bury, Wilt­shire, had the treat­ment, as she tells LUCY HOLDEN.

Dur­ing a rou­tine an­nual mam­mo­gram in Septem­ber 2014, a shadow was spot­ted on my left breast. i’d been hav­ing th­ese check-ups for about ten years be­cause my mother had breast can­cer, and i’d had a scare five years be­fore — a lump which turned out to be a be­nign cyst.

This time i was re­ferred to the great Western Hospi­tal in Swin­don, where i had a se­cond mam­mo­gram and an ul­tra­sound, which also picked up the shadow. Two biop­sies con­firmed it was breast can­cer.

i’d had no symp­toms at all, so it was amaz­ing to me that they had found some­thing. Even when i knew where the lump was, i still couldn’t feel it.

it all hap­pened so fast. But my mother and four close friends have sur­vived breast can­cer, so i was hope­ful that it could be treated suc­cess­fully.

Luck­ily, the can­cer was still earlystage and small (about half an inch), so i could have surgery and some radiotherapy; i didn’t need a mas­tec­tomy.

Then, at one of my ap­point­ments be­fore the surgery, a nurse men­tioned a new treat­ment the hospi­tal was of­fer­ing called tar­geted in­tra-op­er­a­tive radiotherapy, where a sin­gle dose is de­liv­ered into the breast straight af­ter surgery, while you’re still on the op­er­at­ing ta­ble.

it meant i could go home the same day rather than stay overnight, and didn’t have to re­turn to hospi­tal for daily radiotherapy ses­sions for up to six weeks, as is nor­mally the case.

Hav­ing

to go back and forth to hospi­tal wor­ried me al­most more than hav­ing can­cer, be­cause my part­ner is se­verely dis­abled (af­ter a car ac­ci­dent sev­eral years ago left him brain dam­aged) and needs 24/7 care.

it would have been a lo­gis­ti­cal night­mare to ar­range enough care for him, so i was very keen to have the new radiotherapy. un­for­tu­nately, the tech­nique was so new to the hospi­tal that it was still test­ing the equip­ment, so i had to wait four months. But i had reg­u­lar check-ups, which re­as­sured me the can­cer wasn’t grow­ing.

i finally un­der­went surgery and radiotherapy in March 2015. it took about 90 min­utes. af­ter­wards i felt fine, if a lit­tle woozy, and an hour af­ter wak­ing up i was at home — my good friend val stayed with me that night to help me look af­ter my part­ner.

i had a sore arm for a cou­ple of days and a bit of swelling un­der my arm — they had re­moved some of my lymph nodes, which are part of the lym­phatic sys­tem that drains fluid from the tis­sues; the nodes are checked to see if the can­cer has spread.

Two weeks later i went for a scan and was given the all-clear. Two years on, i only need an­nual check-ups, and there is no sign the can­cer has re­turned.

THE SUR­GEON

NathaN Coombs is a con­sul­tant breast sur­geon at Great Western hospi­tal in swin­don. Con­vEn­TionaL treat­ment for breast can­cer in­volves surgery to re­move the tu­mour, fol­lowed by daily radiotherapy de­liv­ered to the out­side of the breast.

But now we can of­fer tar­geted in­tra- op­er­a­tive radiotherapy di­rectly in­side the breast, which is just as ef­fec­tive but saves women weeks of radiotherapy.

The tech­nique was first tri­alled in the uK in 2000. it arose from the knowl­edge that if can­cer re­turned af­ter surgery, it al­most al­ways did so at the same site.

This made the idea of treat­ing the whole breast with radiotherapy af­ter surgery ridicu­lous.

Stan­dard radiotherapy is also stronger, so pa­tients may feel nau­seous, and less ac­cu­rate, so it could damage other tis­sues and or­gans. There should be fewer side-ef­fects with tar­geted in­tra- op­er­a­tive radiotherapy be­cause the form used is softer.

Pa­tients can go home the same day and need not spend weeks com­ing in for daily radiotherapy. it’s a one-stop treat­ment.

it was clear the new tech­nique would suit Lynn. She had can­cer in the left breast, which is closer to the heart, so the risk of stan­dard radiotherapy caus­ing heart damage was raised.

Her tu­mour was also small, which mat­ters be­cause the treat­ment is given us­ing a de­vice called an ap­pli­ca­tor, a sort of sil­ver rod with a de­tach­able ball on the end of it.

The ball — which emits the radiotherapy — is put into the cav­ity once the tu­mour is re­moved, so it needs to be the same size as the tu­mour. We knew it would be pos­si­ble to find an ap­pli­ca­tor the same size as Lynn’s tu­mour.

This treat­ment might not suit some­one with a large tu­mour, or whose can­cer has spread.

We make a small in­ci­sion in the breast and re­move the tu­mour (plus a rim of tis­sue to check it hasn’t spread). Then we mea­sure the cav­ity and fix an ap­pli­ca­tor of the same size on the end of the rod con­nected to the ma­chine that pow­ers the ra­di­a­tion.

We se­cure it in place with tem­po­rary stitches and place lead screens around the breast to re­duce the ra­di­a­tion es­cap­ing into the rest of the room.

Then the ra­di­a­tion is emit­ted di­rectly into the breast area for about 30 min­utes.

AF­TER

that, we rear­range breast tis­sue to fill the gap left by the can­cer, so the pa­tient looks good and doesn’t feel a hol­low that re­minds them of their can­cer. Then we stitch the breast back up. The pro­ce­dure can take up to two hours.

nor­mal surgery takes one hour, but the pa­tient has to come back af­ter­wards for up to 15 radiotherapy ses­sions.

With this, pa­tients can go home the same day with parac­eta­mol for any sore­ness. With con­ven­tional treat­ment, pa­tients must stay overnight af­ter surgery, then re­turn six to ten weeks later for radiotherapy.

now, Lynn comes in to see us for reg­u­lar mam­mo­grams and re­mains well. This tech­nique gives a pa­tient clo­sure. They have one ses­sion and can get on with their lives.

The treat­ment has since been ap­proved by NICE in the six hos­pi­tals in the UK that cur­rently have the ma­chines. it could now be­come avail­able in other NHS hos­pi­tals.

the treat­ment costs the Nhs £2,000, or £11,300 pri­vately.

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