Scripps begins utilizing innovative breast cancer treatment

On the afternoon of Jan. 3, Christine Geckeler had early stage breast cancer. Hours later, she did not.Geckeler, 58, underwent a new breast cancer treatment at Scripps Memorial Hospital La Jolla that allowed her to get all her radiation at once just moments after undergoing a lumpectomy operation.

The innovative treatment, called electron intraoperative radiation therapy (EIORT), which uses a $1.5 million machine called the Mobetron, replaces weeks of radiation treatment with a single dose for select breast cancer patients, said Dr. Mary K. Wilde, breast surgeon and director of the Scripps Polster Breast Care Center.

Wilde started the program two years ago with Ken Shimizu, radiation oncologist. Anuradha Koka, radiation oncologist, and Cheryl Olson, general surgeon, have joined the effort and are also using the new technique. While dozens of hospitals across the country have implemented the technology, Scripps is the only institute south of Orange County that does the procedure with the gold standard electron radiation, Wilde said.

A copper disk is placed under the muscle to protect the tissues below the breast, lungs and heart from radiation, said Koka, who also practices at Scripps Clinic Radiation Therapy Center Encinitas.

A cone that fits into the breast where the lumpectomy was done is then placed so the doctors can see exactly where they need to put the radiation. The machine will deliver the radiation right then and there to that spot before the incision is closed up, Koka said.

The procedure, which has been used in Europe for more than 15 years, only takes about two minutes, Wilde added.

In December 2015, Shimizu and Wilde started replacing one week of the former treatment with EIORT. About 60 people have been treated.

Last December, the Scripps team started the single dosage program.

“In the past, the patients have had a lumpectomy in the operating room, and then they’ve healed up at home for three to four weeks, and then traditionally they would have between four and six weeks of radiation treatment to the breast,” said Wilde. “And we’d be treating the whole breast Monday through Friday for four to six weeks. That’s a big time commitment for these patients.”

Geckeler, technology support manager for AT&T who was diagnosed in November, said she did not have that time and wanted treatment that would better fit her lifestyle.

That’s where EIORT came in.

“My job is always out and about,” said Geckeler. “I do a lot of things that require strength, and one of the things about full-breast radiation is they said I would get tired and it would take six to eight weeks. That did not fit me at all.”

The doctors said EIORT is only available for select patients.

Women must be older than 50 years old, and the tumor must be in the early stage and relatively small. It must also not have spread to the lymph nodes.

“Some patients have tumors that are a little bit more aggressive and have certain biology that we don’t consider safe, so in addition to early and small, they also have to have a favorable histology, meaning the cell type,” Olson said.

The types of patients who qualify for EIORT are in the minority, Wilde said. About 10 percent of the patients the doctors see are eligible for the new single dose treatment, she said.

Olson said the side effects for patients treated with EIORT are minimal.

The surgical procedure is different than traditional methods because of the copper plate being put into place to protect the heart and lungs, she said.

“We dissect the tissue a little bit more to then prepare it for the radiation to be focused on the tissue,” Olson said. “Really, it’s very much the same that we’ve been doing for years. There are actually probably fewer radiation side effects with this treatment.”

Wilde said damage to surrounding tissue is greater with whole breast radiation, though even that is very safe.

“I think it’s very important to remind patients if they aren’t suitable candidates for this kind of treatment and they are getting radiation to their whole breast, the risks of that are very low,” she said. “We don’t want to send a message out that patients who have the regular treatment are at high risk. It’s just that this newer treatment is an even lower risk than the already low-risk traditional treatment. It’s also radiation that’s given while the area is open, so it doesn’t have to go through the skin. You don’t get any damage to the skin.”

The treatment can also be less expensive for patients.

The one-time procedure can cost insurance companies $4,100 while the traditional whole-breast radiation can cost about $28,000 because of the multiple visits, Shimizu said.

Older technology is more expensive than the Mobetron, Wilde added.

“For once, more advanced technology has really decreased the cost of the care,” Wilde said. “This technique is not going to generate as much revenue for the hospital, so there are places across the country that won’t implement this technology for these financial reasons. I admire Scripps so much for being willing to give up the financially lucrative type of radiation for the appropriately selected patient for this type of radiation, which is not going to make the hospital the kind of money that the other kind makes.”

Geckeler said she was relieved to be done with her treatments.

She said she has encouraged her three adult daughters to get routine breast exams.

“Knowing that at my age this option was available to me, I can’t imagine what’s going to be available to them in the event that they have to go through this,” she said. “[Cancer] is all around you. To be a light amongst that darkness is pretty darn good. ... For me, it was a relief knowing that it was over and that I could get off the merry-go-round.”