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Early results positive for technology at Community hospitals

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Dr. Chace Lottich with the intraoperative radiation therapy machine in an operating room at the Indiana Surgery Center at Community Hospital South in Indianapolis.
Dr. Chace Lottich with the intraoperative radiation therapy machine in an operating room at the Indiana Surgery Center at Community Hospital South in Indianapolis. PHOTO BY SCOTT ROBERSON

In the span of 20 minutes, radiologists can now treat some breast cancer patients more effectively than ever before.

Packing a fine beam of radiation at a specific spot in the breast, a new treatment has replaced what previously had taken six or seven weeks. Patients are spared weeks of pain, discomfort, burning and dead tissue.

Early results indicate it’s working.

In March, Community Health Network became the first hospital in central Indiana to offer intraoperative radiation therapy for breast cancer patients. The new technique in treating the disease allows for a single dose of radiation to be given at the time of surgery, rather than for weeks afterward.

At a glance

What is intraoperative radiation therapy?

A radiation treatment that replaces the routine treatment, which requires up to six weeks of daily radiation for women with early detected breast cancer.

How does it work?

Patients receive a single 20- to 30-minute dose of targeted radiation after surgery directly in the area where their tumor was. Radiologists can position the beam while the surgical wound is open, meaning the radiation hits only the tissue where cancer cells still may be present.

Who is eligible to receive it?

Women who:

  • Are 45 or older
  • Are diagnosed with invasive ductal breast cancer
  • Have a tumor less than 3.5 centimeters or the size of a paper clip
  • Have no lymph nodes that are cancerous


  • One-time treatment
  • Less irritation of healthy breast tissue
  • Minimal radiation exposure to the chest cavity and underlying organs
  • Fewer skin irritations, rashes and burns
  • No treatment delay for patients who must also undergo chemotherapy.

With 30 women treated so far, surgeons and radiologists are seeing faster healing times, no burns and a more effective treatment.

“It fits along with our goals to make all treatments more targeted, more specific,” said Dr. Chace Lottich, a breast surgeon for Community Breast Care in Greenwood. “The goal at the end of treatment is to make the patient feel good enough to return to normal life. This speeds up that process.”

Intraoperative radiation therapy works by sending a focused beam into the precise area cancer is removed. After a breast surgeon has cut out the tumor and surrounding tissue, the radiation applicator is set inside the breast.

A rim of tissue surrounds the applicator, meaning that the only tissue that receives radiation is that which was closest to the cancer, said Dr. Erin Zusan, a breast surgeon with Community Breast Care.

“There are fewer side effects because you’re radiating less tissue,” she said.

Traditional radiation treatment, in which machinery aims a wide beam of radioactive particles at the entire breast, can leave women with scarring, burns and nerve damage. While the cancerous cells are killed, healthy tissue also is damaged.

The particles can continue to kill breast tissue three years after treatment is done, Lottich said.

Traditional radiation also takes longer. Because it is not as targeted, patients are required to come for 30 to 35 sessions lasting almost two months.

“From a patient’s perspective, (intraoperative radiation therapy) is more convenient. They don’t have to keep coming back for treatment. Ideally, it’s over in one session,” Zusan said.

The method has been used in the United States since 2000. Community Health bought the intraoperative radiation therapy equipment late last year, and bioengineers have been assembling the components since.

Community’s South, North and East hospitals all have been equipped to provide the therapy.

For the 30 central Indiana women who have had the procedure done as of the end of August, the results have been positive, Lottich said. All have recovered as quickly as women going through traditional surgery and radiation, and many have healed more quickly.

Donna Hacker was the third woman to have intraoperative radiation therapy with Community. Her surgery and radiation was in mid-March.

She opted for the new procedure because it was more convenient.

“I live in Franklin and work in Columbus, so going to radiation every day was going to be pretty hard to do. Of course, I wanted to save my life, and that’s a lot to try and fit in,” she said.

Four months after the treatment, Hacker was fully recovered and cancer-free. She never developed any kind of burns or rashes with the radiation. Her doctors have said that the tissue of her right breast is healthy, showing no further sign of damage.

“It was so much simpler than what I could have gone through. And I’ve been told the success rate is the same in the trials they’ve done, so that’s encouraging,” she said.

Research is ongoing to determine just how effective the procedure is on different types and sizes of cancer, Lottich said.

The clinical trials showed the therapy most effective on women who are older than 45 and who had tumors that are smaller than a paper clip. The cancer must be restricted to one spot in the breast and must be located in a breast duct, Lottich said.

But research from a worldwide study conducted in nine countries has shown that the therapy is as effective as traditional radiation, without some of the side effects, Lottich said.

More hospitals are using the technique as well, which will increase understanding of how well it works. Lottich and other Community surgeons have traveled to Vanderbilt University in Nashville, Tenn., to teach doctors how to use the intraoperative radiation therapy equipment and might do the same for other hospitals in the Midwest.

Because the therapy is new, many women have never heard of it when they come for their initial surgical session, Lottich said. But as more and more people receive it locally, she expects more patients to be informed and choose it for themselves.

“We look forward to be able to offer this to more people as the indications and cell type are more applicable to them. That should only get better in time,” Lottich said.

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