Single-dose intra-operative radiotherapy for breast cancer

Single-dose intraoperative radiotherapy (SD-IORTTM) for breast cancer is considered a safe and effective alternative to conventional external beam radiotherapy for early breast cancer. SD-IORTTM is a single dose given by your breast surgeon in one treatment. It can be a practical and convenient option as it is performed at the same time as the tumour removal and it is usually possible for the patient to go home on the same day.

We caught up with Consultant Surgeon Ekambaram Babu from BMI Bishops Wood Hospital to talk about the treatment in more detail…

Can you tell us about the IORT (intra-operative radiotherapy) procedure at BMI Bishops Wood?

Bishops Wood Hospital Breast Clinic has a wonderful multi-disciplinary cancer care team. Firstly we identify the patient’s suitability for the intraoperative procedure which means we adhere to strict guidelines that are available from a target trial group. Our team consisting of surgeons, a radiologist, an oncologist and a breast care nurse will decide as a group before the patient is booked in for the procedure.

We will look at whether an MRI scan is required to identify if there is more than one tumour in the breast (multi-focal), we also assess the axilla very carefully (armpit region consisting of lymph nodes) by ultrasound and may take a biopsy if necessary using a fine needle. Only if we find that the cancer has not spread to the lymph nodes is the patient suitable for the IORT procedure.

After a wide local excision, we assess the margins (the distance between the tumour and the edge of surrounding tissues) by specimen xray. We also remove skin in front of the tumour, for complete clearance of the tumour. After confirmation of good margin clearance, we plan to give IORT.

Once the radiotherapy is completed we finish the procedure by stitching the wound and the patient goes home on the same day. So far we have never had any problems related to the operation or radiotherapy.

Mr Ekambaram Babu

Mr Ekambaram Babu

Consultant Surgeon

Mr Ekambaram Babu is the clinical lead for breast cancer at The Hillingdon Hospital. He treats both benign and malignant problems of the breast and has a special interest in the oncoplastic management of breast cancer - the concept that encompasses plastic surgery techniques in order to reshape the remaining breast or reconstruct the breast after appropriate excision of breast cancer.

He is the author of publications in peer reviewed journals and has contributed to other medical texts. His research interests include breast and endocrine topics and the development of new surgical and laparoscopic instruments (innovative medicine).

Ok that sounds great. And so with IORT how would you say that this differs, what are the 2 or 3 ways in which this differs from the standard radiotherapy?

Conventional radiotherapy is given to the tumour bed and to the entire breast as well, as the boost is always indirect.

Sometimes it is difficult to identify the tumour bed for conventional radiotherapy, especially when we performed breast mobilisation (mammoplasty) plastic procedures at the same time to maintain similar cosmetic appearance. This is because when the tumour is removed, the scar is far from the site of the tumour; therefore it is sometimes difficult for radiotherapy clinician to identify the right tumour site.

If after IORT, histology and the multi-disciplinary team advise to give conventional external beam radiotherapy, there is no reason not to proceed with that. If the patient needs further excision as well, there is no problem in undertaking the procedure.

Ok and in terms of what happens from a patient point of view what happens during the course of a treatment, what do they need to do before, what happens after?

Once we identify the right patient and the patient is discussed in the multi-disciplinary team, we explain the intraoperative radiotherapy to them. We give printed materials I show a video to the patient and

we take them to the operating theatre where the procedure is performed. They speak to the Oncologist, Surgeon and Breast Care Nurse separately.

Are there any side effects from this kind of treatment?

Side effects of SD-IORTTM can include:

  • redness, dryness and itching around your wound
  • bruising and swelling
  • drainage from where the balloon applicator was placed

A small number of people might also notice fluid build-up, bleeding, infection or that the wound is healing slowly.

If you notice any of these side effects or are worried about anything, talk to your breast consultant or breast care nurse.

We protect the skin, chest and the internal structure throughout the procedure. In external beam radiotherapy you see a lot of skin changes so oncologists will tell you IORT is highly suitable for some special cases such as the morbidly obese, or patients with Parkinson’s or a pacemaker, as they will have difficulty on a traditional radiotherapy machine.

50,000 people are diagnosed with breast cancer in the UK, what advice would you give to anybody in your family and of your friends in terms of being more aware of breast cancer, in terms of any concerns that they may have?

On self-examination, if there is any change in the breast, however young the patient is they should seek advice. If the symptoms persist for more than one or two months, they should seek advice. Nowadays we do not wait for either a lump to appear or bloody nipple discharge of the breast. We would like to diagnose smaller cancers or early breast cancers.

Nowadays we are able to see 30-40% of patients with early breast cancers. In those early breast cancer cases 90% are suitable for intraoperative radiotherapy. Many patients come at the early stages because of self-awareness, media and pamphlets.

However we need to make breast awareness more critical. We still see some large breast cancers and that would need to change by education. We have many investigation techniques available to obtain early diagnosis including the conventional mammogram, ultrasound, digital breast tomosynthesis and MRI scans.

The team at Bishops Wood are up to date with new technology and new techniques.

Find out more about breast cancer and download our breast cancer awareness guide.

Any recommended lifestyle changes?

Good exercise, good food and breast awareness are the most important things.

My last question was really more about you and what motivates you, what inspires you, what’s the thing that gets you out of bed in the morning?

I started studying oncology as my specialty. I came from India with training in oncology, and I trained in oncology of the breast, upper GI, lower Gi and endocrine. I became motivated to move into breast care, specifically focusing on breast cancer. Within breast cancer, the investigations are simple and patients are more aware. Symptoms are easily understood, and we can get a diagnosis early.

I really enjoy working with a wonderful multidisciplinary team – from specialist nurses to administration; they are all very keen to deliver the best care. I’m most privileged to work in such a wonderful environment. And above all, I enjoy the patients I work with, they are so grateful for the small things you do. Overall, the patients, medical groups , supporting staff and management, all make up an incredible team, and I’m quite proud to be a part of that.

We caught up with Claire Hayward, Macmillan Breast Care Nurse at BMI about her role and the specific benefits of IORT over other treatments…

As a Macmillan Breast Care Nurse, my role is to help the patient through their journey after a breast cancer diagnosis. I am here to help with clinical and emotional queries, and have recently set up a breast cancer support group. Since joining BMI Healthcare, I have helped patients who have undergone traditional breast cancer treatment and those who have had SD-IORT.

During conventional therapy the patient has quite a bit of time away from normal activities and daily living. That extended time away from work and home can cause a great deal of tiredness, during what can already be a very difficult time.

SD-IORT can mean there is less disruption to daily life.

If you would like to find out more about the single dose intra-operative radiotherapy (SD-IORT) procedure for breast cancer visit our treatment page or enquire online.

  • Man Men's Health Discover engaging articles dedicated to male health. This includes advice, trends and interviews with our top male health Consultants.
  • Woman Women's Health Stay on top of your health with our tips, advice and Q&A’s with leading women’s health Consultants.
  • Runners Health and Wellbeing Get inspired for a healthier you. Find the latest in healthy living and fitness tips, as well as our medical and treatment updates.
  • Man Men's Health Discover engaging articles dedicated to male health. This includes advice, trends and interviews with our top male health Consultants.
  • Woman Women's Health Stay on top of your health with our tips, advice and Q&A’s with leading women’s health Consultants.
  • Runner Health and Wellbeing Get inspired for a healthier you. Find the latest in healthy living and fitness tips, as well as our medical and treatment updates.