Archive for December, 2012

Breast Cancer Patients’ New Options For Faster Recovery Intrabeam provides one-time treatment instead of 12-week course

Marcia Shanahan’s regular mammogram didn’t show anything. But during a routine check-up, her doctor felt something.

“I really believed at the time it was going to be nothing,” Shanahan says. “But after the biopsy when they said the word ‘cancer,’ it got scary.”

Shanahan felt like she needed a second opinion. On the advice of a friend, she contacted James Edney, MD, a surgical oncologist at The Nebraska Medical Center.

“Women may have two surgical options when they have breast cancer,” Dr. Edney explains. “Mastectomy is one; and breast conservation, where we remove the lump and leave the breast behind is the other.”

Dr. Edney says lumpectomy is followed with a course of daily radiation that typically lasts six weeks.

“This can create a real problem for people depending on their schedule,” Dr. Edney says. “There are geographical barriers, especially when you’re in a place like Nebraska where a patient may have to drive 250 miles a day for treatment.”

He says of all women who get breast cancer, about 75-percent of them are candidates for breast conservation. However, he says only 35-40-percent of that group follows through with conservation because of the logistical barriers and time commitment. When Shanahan met with Dr. Edney to discuss her options, he explained to her a new procedure called Intrabeam, a type of interoperative radiation therapy (IORT). Instead of six weeks of treatment following surgery, Intrabeam patients have their surgery and radiation in one session lasting about 90 minutes.

“It sounded really good,” Shanahan remembers. “I said, ‘Sign me up.’”

After the surgeon removes the tumor, a special bulb-shaped applicator is inserted into the cavity where the tumor was before. The applicator is attached to a portable radiation machine through which a radiologist applies a low-dose of radiation to the affected area and its surrounding margins. The entire process typically takes between one and two hours. Dr. Edney describes it as a team effort between surgical oncologists and radiation oncologists. He also believes this approach will become much more common in the years to come.

“I think that it is our responsibility as an NCI-designated cancer center to provide those kinds of options that may not be available anywhere else.”

The Nebraska Medical Center and UNMC have played an important role in the development of Intrabeam therapy for breast cancer. Their involvement began early during clinical trials when the medical center was one of just four centers in the United States participating. With solid clinical data showing this approach to be effective, it’s now becoming more widely available, though still only available in this region here at the medical center.

“What we found with over five years of follow up, is that the results are equivalent to traditional treatment,” Dr. Edney says. “The cosmetic results were far superior with Intrabeam because we are not irradiating the entire breast and overlying skin.”

Women who undergo whole-breast radiation often deal with red, irritated skin and changes in breast density. Since Intrabeam patients only receive radiation in a small area inside the breast, those side effects are greatly reduced.

Six weeks after her Intrabeam procedure, Marcia Shanahan is back at work. She is undergoing chemotherapy to reduce the chances that the cancer will come back. As she looks back at all she’s been through in the last several months, she is very happy she asked about a second opinion.

“I wouldn’t have known if I had stayed in my original healthcare system,” she says. “I was so excited when I heard there was this option. It made a huge difference for me.”




Rebuilding What Cancer Takes Away

Medical center surgeons take new approach with breast reconstruction


Breast cancer survivor Sunny Reicks talks with reconstructive surgeon Dr. Fredrick Durden

When breast cancer attacked again, Sunny Reicks was unsure if she could go through the recovery process again.

She knew it would be just as hard – if not harder – on her 9-year-old son. This time, he was old enough to understand and ask those gut-wrenching questions no parent wants to answer. She turned to the oncology and plastic surgery teams at The Nebraska Medical Center who controlled and removed the cancer and used an advanced breast reconstruction technique to create new, natural breasts using tissue from other parts of her body. 

Reicks’ journey began in 2005. Just 24 years old, she noticed her left breast felt a little bigger than her right. No big deal, she thought – but better get it checked.

“My mom had breast cancer at 32,” Reicks said. “She advocated self-exams often. She pounded it into my mind.” 

A mammogram and biopsy found cancerous cells that hadn’t spread. Her doctors at the time encouraged her to have both breasts removed (double mastectomy), hoping the cancer wouldn’t return. 

Then in 2011, Reicks noticed a lump on her left breast just six months after having a revision done to her original breast reconstruction with implants. Diagnosed with Stage III breast cancer, she came to the medical center.

First, surgical oncologist James Edney, MD, performed the mastectomy, removing her reconstructed breasts. 

“Seventy percent of my patients opt for a reconstruction the same day as the mastectomy,” Dr. Edney said. “But in Sunny’s case, the extent of the tumor meant we needed to continue with radiation and delay reconstruction.”

That meant Reicks’ next step was radiation and chemotherapy directed by oncologist Elizabeth Reed, MD. 

Plastic surgeon Perry Johnson, MD, advised that the radiation treatments, coupled with the lack of tissue around her implants, made her a poor candidate for breast reconstruction using implants. 

Reicks’ options were limited, but one of them included a different type of reconstruction procedure done by plastic surgeon Frederick Durden Jr., MD.

“Dr. Johnson told me that flap surgery with Dr. Durden was my best option,” Reicks said. “So I researched it and I felt comfortable with what I read about the procedure online and what Dr. Durden showed me.” 

Dr. Durden believes in educating his patients on all the options for breast reconstruction. Theses include prostheses, implants and tissue transfers including rational flaps, free flaps and various microsurgical perforator flap techniques – his specialty. He showed Reicks pictures for each step of surgery. 

“Some women don’t like seeing the pictures, but it’s important to have a serious conversation about the variables involved,” Dr. Durden said. “This isn’t a minor procedure. Patients must be prepared to make a substantial investment of their time and health.” 

Dr. Durden removed tissue from her stomach area in order to reconstruct the new breasts. Almost a full month into recovery, Reicks said the results of the surgery exceeded her expectations. She has dealt with some pain, but she said cancer pain specialist Madhuri Are, MD, has helped her tremendously. She said her new breasts feel a lot different than the reconstructed implants she had previously. 

“They don’t move the same – they don’t sit the same. They’re just more natural – that’s what I like the best so far,” she said. “It also doesn’t hurt to have a skinnier tummy.” 

Nationally, only 25 to 30 percent of women who have a mastectomy undergo reconstruction. Dr. Durden hopes to raise that number not only by providing another surgical option, but by doing a better job of educating women at the right time. 

“We should be introducing women as early as possible, which is as soon as they are advised to undergo a mastectomy,” Dr. Durden said. 

Most women who undergo mastectomies are candidates for microsurgical flap or perforator flap breast reconstruction when natural tissue reconstruction is preferred over implant reconstruction. Many times, the surgery can be done the same day as the mastectomy. Dr. Durden says he’s just excited to give women like Reicks another option for rebuilding what cancer has taken away. 

“I felt this was a place I could really have an impact,” Dr. Durden said. 

“There is no one else nearby who does it,” Reicks said of the procedure. “I’m a single mother. I couldn’t drag my son to New Orleans or somewhere else in order to have this done and recover. If Dr. Durden wasn’t here in Nebraska, I wouldn’t have been able to get the surgery. I wouldn’t trade any of my breast care team: Drs. Durden, Reed, Edney, Johnson and Are. I don’t think there’s a better team anywhere.”