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‘One-shot’ radiotherapy for breast cancer

posted 14/12/2010   expires 14/03/2011

A breast cancer sufferer with Parkinson’s disease avoided the need for a mastectomy thanks to a pioneering treatment.

Maggie Shaw, 68, underwent intra-operative radiotherapy at the Royal Free Hospital. The technique involves giving targeted radiotherapy to selected breast cancer patients while in theatre as soon as the cancerous tumour has been removed.

The only other option for Maggie was to undergo a mastectomy because having Parkinson’s disease meant she would have been unable to lie still for conventional radiotherapy to kill any remaining cancer cells. Maggie Shaw with surgeon Mr Mo Keshtgar and the intra-operative radiotherapy machine

The one-shot radiotherapy during surgery also removes the inconvenience of having to make up to 30 visits to hospital for post-operative radiotherapy.

Maggie, a retired PA from Twickenham, was diagnosed with Parkinson’s disease, an incurable and degenerative disease which affects movement, five years ago. She has problems with walking, her balance and speech although physiotherapy, speech therapy and taking up aqua aerobics for her stiff joints have all helped.

She also suffers from involuntary movements which would have made undergoing conventional radiotherapy difficult as you need to stay still for the treatment.

“Being diagnosed with breast cancer earlier this year was a huge blow, especially as Parkinson’s was already affecting my daily life,” said Maggie.  “It was a shock for my partner, John, and me.” 

“I was devastated when the doctor at my local hospital said that a mastectomy was the only option. I was very persistent and kept asking whether there was any possibility of saving my breast. Eventually, I was told about a pioneering procedure at the Royal Free Hospital which was suitable for certain patients with breast cancer and that I may be eligible.

“The doctor said the technique, called intra-operative radiotherapy, involved giving radiotherapy in one shot during surgery to remove the cancerous lump. It sounded perfect for me as it would mean I could keep my breast and have a significantly less extensive operation.”

Maggie was referred to Mr Mo Keshtgar, a consultant surgical oncologist at the Royal Free. She was a suitable candidate for the TARGIT trial – a trial looking at this new technique – and she had her all-in-one operation in August.

“During the surgery, Mr Keshtgar also performed a sentinel lymph node biopsy. The results were all clear showing that the cancer had not spread. Now I just have to take a daily tablet for five years to prevent the cancer returning.

“Everything went incredibly well. The ward was very clean and the nurses were fantastic. All the staff were very helpful and worked as a team, from the most junior to the most senior.

“My surgery scar has healed very well and I feel well in myself. Only a month after surgery, I was back at aqua aerobics and loving it. Everyone is terrified when they hear that they have cancer but I was treated incredibly quickly: just three months from diagnosis to having surgery and radiotherapy and getting the all clear.”

The TARGIT trial has involved more than 2,200 patients at 28 centres around the world, including the Royal Free Hospital. Early results from the 10-year trial published in The Lancet show that the technique is safe.

Mr Mo Keshtgar, consultant surgical oncologist at the Royal Free and reader in surgery at University College London, has been involved in the trial for the past 10 years. He has recently published a paper on using the technique in patients for whom conventional radiotherapy was not possible.

He believes the procedure could save the NHS more than £15 million a year if widely used for eligible breast cancer patients.

He said: “We believe this treatment will revolutionise the treatment of breast cancer. The trial results show that the technique is safe, is as effective as conventional radiotherapy, has fewer side effects and is far more convenient for the patient, eliminating the need for many trips to hospital for post-operative radiotherapy.

“It is more convenient for patients, saves the NHS money and could reduce waiting lists.”

He added: “I am so pleased that Maggie is delighted with her treatment and that we were able to save her breast. She was an ideal candidate, particularly because conventional radiotherapy would have been impossible for her.

“This technique gives hope to other Parkinson’s disease patients with early breast cancer that their breast can be saved and they do not need to undergo a mastectomy.”

Notes to editors
1. For more information, contact Soraya Madell on 020 7830 2963 or email: soraya.madell@nhs.net

2. The Royal Free is Dr Foster’s ‘large trust of the year’ for 2010. Our services have been rated “excellent” for the third year running, most recently by the Care Quality Commission. The trust attracts patients from across the country and beyond to its specialist services in liver, kidney and bone marrow transplantation, surgery for hepatopancreatobiliary (HPB) conditions, clinical neurosciences, renal, HIV, infectious diseases, plastic surgery, immunology, vascular surgery, cardiology, amyloidosis and scleroderma and are a member of the academic health science partnership UCL Partners. For further information, visit www.royalfree.nhs.uk