How Good Shepherd treats breast cancer with just one dose of radiation
Treating patients with the least invasive methods and fewest visits to the hospital, particularly during the COVID-19 pandemic, is always best, medical professionals would agree.
That's the philosophy of Dr. Barry Rosen, who's been providing specialized early breast cancer treatment for nearly a decade with a team at Advocate Good Shepherd Hospital near Lake Barrington.
Typically breast cancer patients go through several weeks of radiation. Good Shepherd offers intraoperative radiation therapy, or IORT, which consists of a single dose of targeted radiation given during surgery.
The procedure includes a lumpectomy done by Rosen, IORT done by Dr. Andrew Lee, and oncoplastic surgery, which restores the appearance of the breast, done by Dr. Stephen Madry.
The swift approach is what prompted Stephanie Gardiner, 50, of Denver to travel to Illinois with her husband and 10-year-old son earlier this month. The family stayed at a hotel in Schaumburg before and after her Dec. 15 surgery.
Gardiner said she's been getting annual mammograms since age 40, which is how a small tumor was detected in late September. “Before you find out what type of cancer you have, it's pretty nerve-racking. Your mind is racing,” she said.
Her doctor would have prescribed typical radiation therapy, but Gardiner remembered a friend who's been cancer-free since she went through an IORT clinical trial several years ago.
Gardiner asked her health insurance provider for approval for IORT but was denied. She pressed for the criteria and was told only a specific IORT that uses X-rays (some use electrons) would be covered. She was given the names of a few doctors across the country, including two that offer oncoplastic surgery. One was Rosen.
Breast radiation therapy comes with a host of side effects, from mild, common ones like a sunburn-type reaction to more severe ones like breast shrinkage, problems in breastfeeding and even some nerve damage. All that can be avoided with IORT, Rosen said.
“The most wonderful thing is that there are literally no side effects,” he said.
A 12-year clinical trial on IORT published in August shows it is equivalent to traditional radiation for early breast cancer patients. Eligible patients must have very localized breast tumors with specific molecular features, Rosen said.
Rosen traveled to Germany and England to learn the technique before pitching it to Good Shepherd, which made the $500,000 investment in 2011.
“We thought this was a fantastic innovation for our patients — not just from a convenience standpoint but from a precision standpoint,” he said.
When the hospital started offering IORT in March 2012, it was the first to do so in the Chicago suburbs. Since then, Rosen and his team have treated about 500 patients, with cancer recurrence rates of less than 2%, he said.
IORT now is offered by a handful of providers in the greater Chicago area, most recently Cancer Treatment Centers of America, Rosen said. The treatment is covered by Medicare and most insurance companies, although some require patients to jump through hurdles before approval, he said.
The team at Good Shepherd has worked to spread the word to patients and other doctors, Rosen said.
“Breast cancer survival is very high, but we have to look beyond — we have to look at the outcome. It's about going beyond 'I don't care how I look,'” Rosen said. “We should care about the patient experience.”
Meanwhile, Gardiner, whose procedure went well, is back home in Denver where her local medical team will do follow-up care.
“If you get mammograms and you detect it early, you have options,” Gardiner said. “I am thrilled to have options and be able to choose.”