In favor of Breast IORT

1
In favor of Breast IORT David W. Ollila,
MD Associate Professor of Surgery University of
North Carolina, Chapel Hill UNC Lineberger
Comprehensive Cancer Center
2
Needs for IORT to Succeed

• Courageous Patients
• Innovative physicians
• Health care systems willing to be at the cutting
  edge

3
Randomized Trials of Breast Conservation /-
Radiation
4
Failures outside the cavity are uncommon
5
Most in-breast failures Tumor bed
Veronesi et al., Annals of Oncology 2001
6
Intrabeam IORT

• 30-50 kV x-ray
• Spherical applicator

from Vaidya et al. World Journal of Surgical
Oncology 2006 42
7
Comparison of Techniques

• Milano

• UNC

In situ IORT Lumpectomy
Lumpectomy IORT
Arch Surgery 2002
Ann Surg Onc 2007
8
The Machine
9
In Situ IORT to tumor Lumpectomy
Ollila et al., Annals of Surgical Oncology 2/2007
10
UNC Breast IORT Trial
Primary Endpoint Cosmesis
11
Breast Patients Treated Cone Size
12
Breast Patients Treated Treatment (n71)
13
(No Transcript)
14
(No Transcript)
15
(No Transcript)
16
(No Transcript)
17
Criticisms

• In Breast Failures
• MRI?
• Lumpectomy bed
• New Primary
• Under-treatment
• Over-treatment?

18
Multi-site Breast IORT Trial (n96)
Breast Cancers lt3 cm
Ollila, PI
Trial Cost 500,000
IORT UNC technique
In situ IORT lumpectomy
Primary endpoint Cosmesis Secondary endpoint
Lumpectomy bed disease-free survival
19
Conclusions

• Delivering radiation prior to surgical excision
  minimizes the volume of normal tissue treated and
  allows visual confirmation of tumor targeting.
• This technique of intra-operative partial breast
  irradiation results in a good or excellent
  cosmetic outcome in most women.
• Patient satisfaction with IORT was excellent.
• Laboratory-based studies of correlative endpoints
  comparing pre- and post-radiation biopsies in
  both tumor and surrounding normal tissue are
  currently pending.

20
Needs for IORT to Succeed

• Courageous Patients
• Innovative physicians
• Health care systems willing to be at the cutting
  edge

21
Collaborators

• Carolyn I. Sartor
• Joel Tepper
• Larry Marks
• Randall J. Kimple
• Nancy DeMore
• Keith Amos

• Cherie M. Kuzmiak
• Dag Pavic
• Jun Lian
• Sha Chang
• Chad A. Livasy
• Rachel F. Phipps
• Laura Esler
• Xi-Hui Yang

Thanks To our brave patients who shared our
vision