Oncology Central

One dose, one treatment, one day – interview with Richard Simcock

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In this interview, Consultant Clinical Oncologist Richard Simcock discusses single-dose intraoperative radiotherapy (SD-IORT) for early stage breast cancer – a procedure that allows a patient to receive surgery and all of their radiation treatment at the same time. Read on to discover more about SD-IORT, how it compares with daily external beam radiotherapy (EBRT) and details of a recent SD-IORT study that reported positive patient experience outcomes.

OC: Could you please introduce yourself and tell us a little about your career to date?

RS: I am a Consultant Clinical Oncologist at the Sussex Cancer Centre based in Brighton (UK). I have been there since 2004. I treat breast cancer in a multidisciplinary setting based at the Park Centre for Breast Care. Before joining the team at Brighton, I had trained in London (UK) and Sydney (Australia). I am the co-author of the ABC of Cancer Care [1] and am a member of the Expert Reference Group for the treatment of older people with cancer. I am also helping to coordinate a free medical education resource for radiation oncology professionals – Radiation Nation [2].

OC: What are the current standard-of care treatment options for patients with early stage breast cancer?

RS: Surgery is a curative procedure in the majority of patients and is offered whenever possible. With the safety of modern anaesthetic and surgical techniques it is most often the case that surgery can take place. Surgery to conserve the breast (wide local excision) is preferred wherever possible, but mastectomy may be necessary according to tumor stage and/or breast size. Modern oncoplastic techniques significantly reduce any cosmetic detriment resulting from surgery.

After breast conserving surgery, postoperative EBRT to the whole breast is considered a standard therapy in the majority of patients to reduce the risk of local recurrence. Recent large UK trials (START and FAST) have demonstrated that this radiotherapy may be delivered in less fractions than traditional hypofractionation, and the majority of radiation courses in the UK are now given in 15 sessions.

Very recent data from the IMPORT LOW study also suggest that in low risk patients the radiotherapy can safely be confined to the area of the breast the tumor was removed from when using external beam treatment over 15 fractions. Restricting treatment to part of the breast is referred to as partial breast irradiation (PBI). There are some patients for whom the risk of a recurrence is so low that the protection from hormone therapy alone is enough that radiotherapy can safely be avoided altogether (this was shown in the UK PRIME 2 study). Risk of recurrence can be estimated using calculators like ‘IBTR!’ [3].

OC: What are the downsides associated with standard daily external beam radiotherapy for patients with early stage breast cancer?

RS: EBRT is time consuming for the patient. A conventionally delivered course of therapy will require 16 visits to the treating center; one for simulation/measurement and 15 separate visits for ‘fractions’ of treatment. Treatment centers are most often regional and therefore it is not unusual for patients to have to travel significant distances for their treatments. This daily requirement for treatment is disruptive to home and work life, and may present very real challenges to the older person. The need to attend for treatment is very off putting to many patients and duration is important; a recent study demonstrated that 47% of mastectomy patients in Australia would have chosen breast-conserving surgery if duration of therapy was 3 weeks rather than 5 weeks [4].

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