Magic ball that spares breast cancer patients gruelling weeks of radiotherapy
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.
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.
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.
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.