Advanced radiation therapy offers patients more time, fewer side effects

Eradicating any microscopic cancer cells, and therefore reducing the risk of recurrence, is the ultimate goal of radiation therapy, says Lewis Cancer & Research Pavilion Radiation Oncologist Dr. John Pablo

Surviving breast cancer is a journey marked by many moments of profound courage. First, most patients must undergo surgery to have the cancerous tumor removed. But the relief felt after a successful operation is often tempered by a quiet anxiety: were any cancer cells left behind?

That’s the question that drives radiation oncologists like Dr. John Pablo, medical director of the Nancy N. and J.C. Lewis Cancer & Research Pavilion’s Radiation Oncology Center in Savannah, Bluffton and Hilton Head. Eradicating any microscopic cancer cells, and therefore reducing the risk of recurrence, is the ultimate goal of radiation therapy. Advanced technology is helping physicians achieve that goal with fewer side effects and more time saved for the patient.

“We begin by evaluating risk based on the pathology from the surgery,” Dr. Pablo says. “For many women, there is no cancer left. But if the risk is high enough that it could be there, we can treat with radiation and reduce that risk significantly.”

Pinpoint Precision

The surgical procedure to remove a breast cancer tumor is known as a lumpectomy. The tumor is removed along with a small border, or margin, of healthy tissue around it. Pathology determines if the margins are clear, meaning no cancer cells found.

Some cases will require a mastectomy, in which the entire breast is removed.

In either case, there could be microscopic, undetectable cancer cells within the remaining breast or on the chest wall. Radiation therapy works by using high-energy ray to target and destroy these cells.

Dr. Pablo uses advanced imaging to create detailed, three-dimensional maps of the patient's body and the area to be treated. This allows him to aim the radiation beams with incredible accuracy. Breast cancer patients are treated with TrueBeam, an advanced radiotherapy system that delivers the beams with pinpoint precision. The beams can even be adjusted down to the millimeter.

“With such a precise tool, we can minimize the dose of radiation delivered to surrounding healthy tissues and critical organs, such as the heart and lungs,” Dr. Pablo says.

TrueBeam can also synchronize the radiation beam delivery with the patient's breathing. Patients take a deep breath and hold it, which expands their lungs and moves the heart away from the chest wall. Then TrueBeam delivers the radiation only when the patient is holding their breath in the desired position. This significantly reduces the risk of radiation exposure to the heart.

The advanced technology also means less time on the treatment table.

“It only takes a few minutes for the TrueBeam to deliver the radiation,” Dr. Pablo says. “It’s a much more comfortable and convenient patient experience.”

A Widening Scope

Dr. Pablo and his colleagues at the Lewis Cancer & Research Pavilion understand how important saving time can be for patients who feel like their life has been put on hold by cancer treatment.

“We’re doing more three or four-week courses of treatment now, whereas in the past the standard was six weeks,” Dr. Pablo says. “Some patients are eligible for just five treatments of radiation. These shorter sessions can reduce the time burden for many women.”

Dr. Pablo is encouraged by recent clinical trials that have demonstrated the widening scope of patients eligible for shorter treatments.

“As radiation oncologists, our goal is to eliminate cancer effectively, but also to minimize its impact on our patients' lives,” he says. “Advanced technology has allowed us to offer significantly shorter radiation schedules, and I think that eligibility will expand even further in the future. This means that the ability to regain time and return to normal routines faster will be available to more patients and survivors.”