UNC: IORT Experience

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UNC IORT Experience David W. Ollila,
MD Associate Professor of Surgery University of
North Carolina, Chapel Hill UNC Lineberger
Comprehensive Cancer Center
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Breast Cancer Facts 2007

• 180,000 new cases
• 40,000 deaths

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Surgical Pursuit of Less in Breast Cancer Patients

• Radical Mastectomy
• Modified Radical Mastectomy
• Partial Mastectomy (Lumpectomy)
• Sentinel Node Procedure

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Radiotherapy Pursuit of Less in Breast Cancer
Patients

• Comprehensive chest wall XRT including
  supraclavicular and axilla
• Whole breast XRT
• Partial breast XRT
• No breast XRT

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Randomized Trials of Breast Conservation /-
Radiation
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Most in-breast failures are in the tumor bed
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Accelerated Partial Breast Irradiation

• Radiation as part of Breast Conservation
  delivered faster than normal i.e. 16-30 days
• Multiple techniques with 3-5 year follow-up for
  most techniques
• NSABP B-39/RTOG 0413
• ongoing randomized trial APBI vs WBRT
• 4300 patients

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Multi-catheter brachytherapy
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Mammosite
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Intra-op Comparison of Techniques

• Italian

• UNC

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The Machine
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Tumor Positioned in Center of Cone
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Bookwalter Attached
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Docking
From Ollila et al Annals of Surgical Oncology
14(2)660669
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Final Position
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LCCC 0218
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Multi-site Breast IORT Trial (n96)
Breast Cancers lt3 cm
Ollila, PI
Trial Cost 500,000
IORT UNC technique
In situ IORT lumpectomy
Primary endpoint Cosmesis Secondary endpoint
Lumpectomy bed disease-free survival
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Collaborators

• Carolyn I. Sartor
• Joel Tepper
• Larry Marks
• Randall J. Kimple
• Nancy DeMore
• Keith Amos

• Cherie M. Kuzmiak
• Dag Pavic
• Jun Lian
• Sha Chang
• Chad A. Livasy
• Rachel F. Phipps
• Laura Esler
• Xi-Hui Yang

Thanks To our brave patients who shared our
vision