Courtney Collen (Host): Hello! Welcome to One in Eight, a new health podcast series brought to you by Sanford Health. I’m your host Courtney Collen with Sanford Health News. We’re starting new conversations to shine a light on breast cancer awareness because one in eight women will be diagnosed with breast cancer during her lifetime. Today, we’re talking with Dr. Michelle Lohr, a radiation oncologist at the Sanford Cancer Center here in Sioux Falls and we’re talking all about treatment and a specific type of radiation therapy for breast cancer.
Dr. Lohr, welcome.
Dr. Michele Lohr: Thank you, Courtney. Thank you for having me.
Courtney Collen (Host): Thank you for being here. Tell us what you do here at the cancer center.
Dr. Michele Lohr: So I’m a ABR certified radiation oncologist. So I consider myself an oncologist, but I treat patients with radiation versus chemo or surgery, but we all work as a multidisciplinary team.
Courtney Collen (Host): What do you enjoy most about being a part of Sanford, specifically working with cancer patients?
Dr. Michele Lohr: I love the multidisciplinary approach that we have to treating our cancer patients. We all work here as a team and a family, and all of our patients that are diagnosed with the cancer are prospectively brought to a multidisciplinary tumor board where all of the physicians and healthcare providers that are participating in their care, get together and review the cases before we decide on a treatment. So there are six or seven multidisciplinary tumor boards each week. Each of them specializing in a different site and we have a specific breast cancer tumor board that the breast surgical oncologist is present medical oncology, radiation oncology, the pathology, radiology, nuclear medicine, genetics, our social workers, our nurse navigators are all there… and we present the patient’s case to come up with the best plan of care. So working with my patients, of course, but I’m working with my colleagues to formulate the best plan of care for our patients is really what I love.
Courtney Collen (Host): What is radiation therapy?
Dr. Michele Lohr: So radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. And radiation works by making small breaks in the DNA inside the cells. These breaks keep cancer cells from growing and dividing and cause them to die.
Courtney Collen (Host): This specific conversation is focusing on a certain type of radiation therapy and that’s the IORT. So Dr. Lohr, what is IORT and what does it stand for?
Dr. Michele Lohr: So IORT stands for intraoperative radiation therapy. Intraoperative because radiation is delivered during surgery, directly into the cavity where the tumor has been removed. It requires fewer radiation treatments and lowers the risk of exposure to surrounding healthy tissue and organs. If you determine that a patient would benefit from IORT, this of radiation therapy, walk us through that treatment process and what that looks like.
Dr. Michele Lohr: So, first of all, we, we determine whether or not a woman is a good candidate for IRT. We utilize ASTRO guidelines, which is the American Society of Therapeutic Radiation Oncology. They’re evidence-based guidelines that help us determine who is a good candidate for IORT. And typically that is a woman that has had a screening-detected lesion that turned out to be malignant that they’re typically older in age 65 or older is our guideline. The ASTRO guidelines are a little bit more lenient with age, but we are following a little bit stricter course just to be safe and minimize local recurrences. It has to be a small lesion. It needs to be estrogen receptor positive, and clinically, the patient doesn’t have any evidence of lymph node involvement. So when that patient has been first diagnosed with their cancer and they appear to be a good candidate for IORT, they’re referred to one of our fellowship of one of our breast surgeons. Then that breast surgeon will evaluate that patient for their suitability for IORT, which is performed in conjunction with the lumpectomy, not a mastectomy, but a lumpectomy where the actual cancerous tumors removed and then it’s paired with the IORT to be a form of what we call accelerated partial breast radiation so we’re treating just that site. If the surgeon feels that the patient is a good candidate for IORT, the patient is then set up to see myself for one of my partners to also review the benefits, the pros and cons of a single fraction, intraoperative radiation therapy, and determine if they are a good candidate. So then we get back together, the surgeon and myself, or one of my colleagues and say, ‘yes, we feel this patient is a good candidate’. And if they would like to go forth their setup then for their surgery in a relatively short timeframe.
Host: What makes a good candidate for this type of therapy?
Dr. Michele Lohr: So the ASTRO guidelines are, have a suitable, cautionary and unsuitable guidelines. And so it’s typically per the ASTRO guidelines that somebody 50 and older, a woman 50 and older, our guidelines are a little more strict just to make sure that we are really choosing those low-risk breast cancer patients. So right now a 65 or older is our typical age. They have to have a screening-detected abnormality – not that they felt the lump and then presented because those we know tend to be higher -risk cancers. It should be a low-to-intermediate grade cancer. The lymph nodes should clinically be a negative and it should be estrogen receptor positive.
Host: How long does this type of treatment take?
Dr. Michele Lohr: The beauty of the IORT is you are providing a dose of radiation, right to the lumpectomy cavity after the tumor has been removed. So you’re just treating part of the breast, but the, the part of the breast, that’s at the highest risk for recurrence and it’s done right at the time of surgery, the patient is still asleep and the actual delivery of the radiation takes anywhere between eight to 10 minutes. When the patient wakes up, they’re done, and hopefully there won’t be any need for any additional radiation therapy.
Host: How long has this type of treatment been around or been available here at the cancer center?
Dr. Michele Lohr: IORT has been around for decades. Europe has been using it for many, many years. And it’s been in the U.S. quite a while. We brought it here in October of 2018 was our first case. And since then we’ve treated over 30 women.
Host: Is it expensive for the patient?
Dr. Michele Lohr: You know the, the cost from a technical standpoint is actually very similar to a course of external beam, radiation therapy, which is still the gold standard of care after a lumpectomy. But the, you know, the time cost is much less because the patient doesn’t have to come in for radiation therapy on a daily basis afterwards.
Host: What about the success rate for patients undergoing this type of treatment?
Dr. Michele Lohr: Several randomized controlled trials have been done looking at local control and in the appropriately selected low risk breast cancer patients, the local control is really very comparable to whole breast radiation therapy.
Host: Now, how would a woman know this treatment is right for her? Walk us through that process. Once she’s diagnosed, what happens next?
Dr. Michele Lohr: You referred to one of our breasts service surgeons and she meets with them and they go through, you know, the characteristics of the tumor that’s been found and what one of the important things is it can’t be too large and it can’t be too close to the skin. And the surgeon with the patient will determine whether or not they’re a good candidate and whether or not they’re interested in having accelerated partial breast radiation or IRR Breast cancer.
It is not it’s been used to treat many types of different cancers, pancreas cancer recurrent cancers in the pelvis sarcomas. When we think about breast cancer treatment, the gold standard of care for an early breast cancer is breast-conserving therapy, which is a primary surgery with a lumpectomy followed by radiation therapy. The gold standard of radiation therapy is to treat whole breast radiation therapy several weeks after you’ve had the lumpectomy and healed the most common fractionation scheme of that radiation therapy to the whole breast is somewhere between three to five weeks of radiation therapy on a Monday through Friday basis. So IORT is a form of what we call accelerated partial breast radiation, where we’re treating just the lumpectomy cavity, which is at the highest risk for recurrence, and there’s actually various forms or various ways to provide accelerated partial breast radiation. We can do it with external beam radiation. We can do IORT, there’s a balloon brachy therapy, such as mammoth site, and Contura, there’s interstitial catheters. We chose to use IORT as our form of accelerated partial breast radiation because it is so convenient for the patient, they have the single treatment done at the time of surgery and hopefully then they’re done.
Host: How far have we come in providing these options for our patients here at Sanford?
Dr. Michele Lohr: I think we’re constantly bringing in new technology, new medicine, new research, and in the last 10 years, it’s just been a huge change in oncology in the whole field.
Host: Yeah, it’s incredible. The mammogram is so important when it comes to prevention for breast cancer. That’s step one, isn’t it? Talk about the importance of getting that mammogram.
Dr. Michele Lohr: Sanford still supports a woman getting a mammogram every year, as long as she’s a standard risk. There are those patients that may be a little bit higher risk due to family history or other reasons. And we do have a specialty breast clinic for those patients so that they can be followed a little bit closer. For the average woman, we recommend annual mammograms.
Host: What else do you want our listeners to know today, Dr. Lohr, as we really shine a light on this type of treatment and breast cancer in general?
Dr. Michele Lohr: Really being sure you do get your screening mammograms and do self breast exams, and then living a good, healthy lifestyle I feel is so, so important. We have good research to tell us that even women that have been diagnosed with breast cancer will do better if they exercise, maintain a healthy body weight, do not drink too much alcohol and or ingest too much fat. So I really believe that regular daily exercise and a good, healthy lifestyle is so important.
Host: Dr. Lohr, thank you so much for joining me in this conversation to give us a little bit more insight into one of – what it sounds like – many treatment options for women who are diagnosed with breast cancer, we appreciate your time and all that you do here.
Dr. Michele Lohr: Thank you so much, Courtney. Appreciate you having me.
Host: I’m Courtney Collen. Catch the next episode of One in Eight, our cancer podcast series coming soon. Stay well and have a great day.