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Historical
Development of Breast Cancer Treatment:
Over the years, there has been a gradual improvement
in the treatment of localized breast cancer. Initially incurable, breast
cancer therapy has not only improved cure rates, but also allowed women to
keep their breasts.
At the turn of the century,
there was no known cure for breast cancer. Dr Halstead first showed it could
be cured with a dramatic new operation, called the Halstead Radical
Mastectomy. This surgery involved removing the entire breast, pectoral
muscle and lymph nodes. As horrible as this sounds today, it was a dramatic
step in showing that breast cancer was potentially curable.
The first real modification occurred in the 1950s.
The pectoral muscle was left, and resulted in the Modified Radical
Mastectomy. The cure rates were later proven to be identical to the Halstead
Radical, but with a dramatic improvement in cosmetics and decrease in
complications. These were primarily decreased lymphedema (arm swelling) and
improved arm mobility. The cosmetic improvement was the ability to wear
lower cut blouses and short sleeves. Sounds so modest today but were huge
improvements then.
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Plastic Surgical
Reconstruction: The early 1960s saw the introduction of Plastic
Surgical breast reconstruction. Cosmetics became a very important factor.
Physicians became increasingly aware of the horrible psychological impact
mastectomy was having on their surviving ladies.
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Lumpectomy (Breast
Preserving Therapy): The mid 1960s saw an innovative Surgeon, Oliver
Cope and his cohorts Radiation Oncologist Sam Hellman invent a dramatic
new procedure. Accepting for the first time that radiation could indeed
cure small amounts of cancer, they combined “limited” surgery with breast
radiation to preserve the ladies breast. This procedure is affectionately
now called “Lumpectomy” (other references are “quadrant resection”, “wedge
resection”, “wide local excision” etc), and Radiation. Again the long-term
studies showed equivalent cure rates to the Modified Radical Mastectomy,
but dramatically better acceptance of treatment by ladies and spectacular
improvement in post-cancer treatment psychological healing.\
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Since the widespread
acceptance of lumpectomy as primary therapy for breast cancer, there have
been a number of innovations to the overall technique. Initially, the
lumpectomy was followed by five weeks of external beam radiation (EBRT)
combined with interstitial brachytheraphy.
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External Beam Radiation
Therapy (ERBT): The ERBT was and still is accomplished with a
radiation machine called a linear accelerator (high-energy x-ray machine).
Treatments are given daily, as an outpatient, Monday through Friday, and
take 10 to 15 minutes on the machine.
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Brachytherapy Boost
Radiation: The original brachytherapy was accomplished by
surgically inserting a number of needles through the breast in the area
where the original tumor had been removed and where there may be residual
cancer cells. The tubes were then “loaded” with a radioactive material
called Iridium-192 (Ir-192). Iridium was delivered to us as tiny rice
sized pellets imbedded in plastic tubes. This “ribbon” of Ir-192 was slid
into the hollow needles and left in long enough (typically took two days
or 48 hours in the hospital) to deliver the radiation dose needed to
destroy the residual or remaining cancer. This comprised the “boost”
radiation, allowing the delivery of very high doses of radiation to the
potentially largest clumps of cancer cells that may have been left behind
by the surgeon.
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Team Approach to Cancer
Treatment: Indeed, it was surgeon Dr Cope’s confidence in his
radiation therapy colleagues that allows this treatment to be given,
rather than removing the whole breast. Dr Tokita had the privilege of
learning directly from Dr Cope in 1976 and introduced Breast Preserving
Lumpectomy and Radiation to Southern California, while founding and
directing the a Radiation Department in Torrance California.
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