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The era of single-dose radiotherapy during surgery begins… 

What is Single-Dose Radiation Therapy?

In patients with breast cancer, radiation therapy can be completed with a single-dose application done using the Intra Operative Radiotherapy (IORT) method during surgery. Once the tumor in the breast is removed in an operation, the special applicator in the tool is placed in the tumor area. Following the necessary calculations, high-dose radiation is given only to this area, completing all local treatments and protecting healthy tissue.

How is Traditional Radiotherapy Applied?

Radiation therapy is carried out with “linear accelerators” that produce photons and electrons, in specially protected rooms in hospitals’ Radiation Oncology departments. In almost all cases that have been diagnosed with breast cancer and treated with “protective surgery” (in which only the portion of the breast with the tumor is removed and the rest of the breast is left intact), radiotherapy is needed following the operation.

Radiotherapy begins preferably after chemotherapy in patients who require it or at least 3 weeks after surgery in patients who are only treated with hormone therapy. In patients who’ll receive radiotherapy for the breast, tomography cross-sections with 2-mm increments are first taken using a computer for planning purposes. Later, arrangements are made to apply the necessary dose to the areas under risk in the breast that’ll receive radiotherapy while protecting the healthy organs (the heart, main arteries of the heart, lungs, other breast, etc. where the illness hasn’t spread). Once the plan is approved, the patient receives radiation treatment for 5 to 7 weeks, dependent on the condition of the illness and determined by the radiation oncology doctor. Other patients still receive a short-term treatment called hypofraction, which lasts 3 weeks.

Advantages of Single-Dose Application

The single-dose application done with the Intraoperative Radiation Therapy (IORT) tool utilizes a linear accelerator in very much the same way that traditional radiotherapy does. This method is used in an operating room using a safe and portable tool that operates in a linear and accelerated manner, only producing electron energy but not requiring too much protection for the personnel like traditional linear accelerators do. In addition to the surgical team carrying out the operation, a radiation oncology specialist and a medical physicist are also present in the operating room. This way, radiotherapy is completed at the same time as the surgery. A significant advantage for the patient is that there is no need to wait for the wound to heal following surgery, or to plan radiotherapy and visit the hospital each day for treatment. This way, the total duration of the treatment is also cut down.

During the operation, once the tumor in the breast is removed, the special applicator within the tool is placed in the area where the tumor is. Following necessary calculations, the high-dose radiation is given only to this area, completely protecting healthy tissue. Although single-dose application or using different methods to apply radiation only to the tumor area as opposed to the entire breast are methods that have become more globally accepted in recent years, single-dose application isn’t for every patient. The decision whether a patient is suited to receive this treatment must be made collectively by the radiation oncologist, the surgeon and the pathologist dealing directly with the patient. The patient’s age, the size of the tumor and other pathological qualities of the tumor play an important role in this decision.

Who Receives the Radiation Boost?

Patients under the age of 50-60 are not considered to be ideal candidates for single-dose application. In these patients, it is necessary to apply radiation to the tumor area following radiation application to the entire breast in the traditional method. Once the treatment of the entire breast area is completed within 25 to 28 work days, excluding weekends, instead of the entire breast, only the area where the tumor was removed is treated with radiation, which takes around 5 to 8 work days depending on the patient and the patient’s circumstances. Applying radiation to the area with the tumor is called a radiation boost. Thanks to the IORT method, the radiation boost is delivered as a single dose during the operation, after which the entire breast is subjected to radiation and the total treatment duration is cut down.

Applying Radiotherapy to the Nipple Complex

Breast-protective surgical treatment may not be suitable for some patients. In patients where the entire breast needs to be removed, the nipple and its surrounding area are left intact for a better cosmetic result. This is called nipple-sparing mastectomy. A single dose of radiation is applied to the nipple and the tissue right underneath using the IORT method to lower the risk of recurrence here. The radiation boost is offered for the first time in Turkey at Acıbadem Maslak Hospital Breast Health Center.