UVa doctor couple gets $1.8M to test one-stop breast cancer approach

November 26, 2018

Originally published by The Roanoke Times 

CHARLOTTESVILLE — A husband-and-wife team of doctors at the University of Virginia has pioneered a system of breast cancer treatment that allows a patient to receive a single dose of radiation at the same time as surgery and then go home without weeks of additional doses.

Dr. Timothy Showalter, a radiation oncologist, and Dr. Shayna Showalter, a breast cancer surgeon, have been perfecting the procedure since 2014 and recently received a $1.8 million grant from the National Institutes of Health to research its outcomes. The knowledge they gain, the Showalters said, should provide more insights into making breast cancer treatment less invasive and more convenient.

“It’s amazing how much patients have latched on to this; they just intuitively understand the convenience of getting it all done at once,” Shayna Showalter said.

The procedure is ideal for women who are over 45 and have early-stage cancer. It combines a lumpectomy, a CT scan and radiation into one visit to the UVa Medical Center.

Standing next to each other in a special operating room, Shayna Showalter opens an incision and removes the tumor. Tim Showalter inserts a brachytherapy catheter and their team takes scans using CT imaging to ensure it’s in the right spot on the tumor bed. A high dose of radiation is delivered through the brachytherapy to the targeted area; then it is removed and the incision is closed. While patients must return for standard follow-ups, there should be no need for future doses of radiation.

“Breast cancer used to be treated with these big surgeries, then lumpectomies, which still took lots of time and lots of radiation,” Tim Showalter said. “In the past 30 years, there has been a big push to do partial breast radiation.”

Many hospitals now offer intraoperative radiation therapy, rather than irradiating the entire breast over the course of weeks, which can expose the heart, lungs and skin to harmful doses of radiation. However, UVa was the first to use a CT scanner on rails to check the location of the tumor and radiation delivery without transferring the patient to another room or making them return for another visit, the Showalters said.

“From the patient’s standpoint, it’s about the convenience,” Shayna Showalter said. “Sometimes we say, ‘Oh, you have cancer, you should do whatever you need to,’ but people also have busy lives and are concerned about weighing the risks of treatments versus what the benefits of those treatments are. We are able to provide them a treatment that doesn’t damage the heart and lungs, and people know that and understand that benefit.”

A phase I clinical trial established the safety of the precision breast IORT treatment. Now, the five-year grant, written by the researchers on top of juggling clinical responsibilities and taking care of their three children, will give them the time and funding to determine how effective the treatment is.

“It’s a huge validation not only that this is an interesting thing, but also gives us the leeway to do this,” Shayna Showalter said.

The Showalters believe this approach has less of a negative effect on the immune system than other methods of radiation, and will use the study to measure patients’ immune responses. The phase II trial also hopes to confirm that local cancer recurrence rates are at expected levels, Tim Showalter said.

“Patients come in, they have their radiation and they have their surgery, so the bulk of their treatment for their breast cancer is completely finished all in one thing, so it allows patients not only to physically move on if they have jobs and kids, but also to mentally move on,” Shayna Showalter said.

The researchers are still accepting applicants for the trial. More information about current treatment at UVa and ongoing trials can be found at uvahealth.com/services/breast.

Read the full story at The Roanoke Times