Intraoperative radiotherapy (IORT) is a viable option when it comes to surgery to remove tumors: Unlike external radiation therapy, the tumor bed is irradiated immediately after surgery. The benefit is that the skin and the surrounding healthy tissue is protected and the length of radiation is shortened. This can reduce associated side-effects and is more gentle on patients. With certain kinds of cancer, such as breast cancer, follow-up radiotherapy can be reduced and in some cases even eliminated completely – a key element to increasing quality of life.
ZEISS is working closely with breast surgeon Dr. Hans-Christian Kolberg. The interview* was conducted at the hospital in Bottrop.
Dr. Kolberg, your personal focus is on gynecological oncology and you have been heading the Gynecology and Obstetrics unit at St. Mary’s Hospital in Bottrop since 2005. What do you think of the developments in intraoperative radiotherapy that we’ve seen over the past few years?
Until about 10 years ago, IORT was a totally experimental, non-traditional method that no one in the community of classic radiotherapy really took any notice of. Meanwhile, there are recommendations to use IORT made by organizations like the German Society for Radiooncology (DEGRO) and the American Society for Radiation Oncology (ASTRO). IORT has become firmly established in breast cancer treatment.
What do you see as the benefits of intraoperative radiation?
In practical terms, patients have the benefit of time – this method means they don’t need to factor in time for 15-25 external radiotherapy appointments, and that means low costs for healthcare. In some parts of the world, such as in China, there aren’t that many centers for external radiotherapy – and that’s been the case for quite some time. Patients here are more likely to have their breasts removed. IORT could also give people in these parts of the world ever greater access to breast-conserving treatments.
What are the potential health benefits?
The skin is exposed to less radiation toxicity as the tumor bed is irradiated immediately after surgery - the wound is used for this purpose. The benefit is clear: Given the uncertainty associated with external radiotherapy, i.e. whether the right area is being irradiated, IORT radiation is focused on the tumor itself – and therefore on the area with the highest chance of recurrence. For patients who have undergone oncoplastic surgery, where the tumor is removed and combined with plastic reconstruction of the breast, IORT can be a real blessing. After all, in this case we have no way of knowing whether the external radiotherapy boost applied by the physician is hitting the tumor bed or healthy breast tissue.
You’re a chief surgeon at a teaching hospital. What advice do you give other doctors on IORT?
As a community of doctors, we should ensure, by sharing scientific data, that more and more patients can benefit from this treatment option. I would urge doctors to examine patients to see if they would be good candidates for IORT treatment - at the very least, this should happen at breast cancer centers where the technology for IORT is available.
Dr. Kolberg, thank you very much for talking to us!
*The interview was conducted on 23 March 2017 at the clinic for gynecology and obstetrics in Bottrop, where Dr. Hans-Christian Kolberg is chief surgeon.