UA-35946176-3
1983
 

Breast-sparing treatment proves to be a success in European trial

Mamma int BCT.jpg 

Brachytherapy after sparing surgery, whereby not the whole mammary gland but only the tumour is removed. For the purpose of irradiation, hollow needles are inserted into which radioactive iridium wires are placed for the treatment.

In 1978, Harry Bartelink, during a working visit to the Institut Gustave Roussy in Villejuif (near Paris, France), learns about a new way of treating breast cancer.  The new treatment consists of a combination of breast-sparing surgery followed by irradiation. The results seem to be just as good as with the traditional treatment, where the breast with the tumour is completely removed - a radical mastectomy.  Bartelink is convinced of the possibilities and advantages of this new method.  Back at the Netherlands Cancer Institute (NKI) he introduces breast-sparing treatment together with surgeon Joop van Dongen [64].

In order to confirm the value of the new breast-sparing treatment as compared to breast amputation, Bartelink and Van Dongen set up a comparative clinical trial organised in 38 European hospitals. Between 1980 and 1986 more than 900 patients are treated according to a carefully standardised protocol. This trial (EORTC 10801) is a great success. The breast-sparing treatment was just as effective with regard to survival and tumour relapse [64]. Bartelink: "Not only did this mean that the old standard, radical mastectomy was out of date, it meant also that patients came to view the disease in a different way".  So long as radical mastectomy was the standard treatment for breast cancer, women were not inclined to have early treatment. It was also a mutilating procedure. When the breast-sparing operation became a viable alternative, this attitude changed. Getting early treatment meant increasing the chance of survival, while preserving the breast.

It was expected that many women would seek treatment with this method and the Radiotherapy Department of the NKI prepared itself for the increase in patients.  Radiotherapy can be given using external megavolt irradiation or with brachytherapy in which a radioactive source is placed in the breast during the surgical procedure. In the NKI, the second option is preferred, in particular due to the possibility of limiting unwanted irradiation to a greater depth. 

microselectron mamma test klein.jpg 

1985, the microSelectron-LDR automatic afterloading unit, manufactured by Nucletron,  seen here in the workshop of the NKI connected to a model of a breast in which a number of needles have been placed.

 

The need arises for an automatic afterloading machine with which the irradiation can be given rapidly and safely.  Together with physicist Meertens, Bartelink convinces the inventor and entrepreneur Erik van 't Hoofd to develop a new type of automatic afterloader at his company Nucletron. This is the microSelectron-LDR, of which the first machine is delivered in 1985, the second following in around 1987. With this machine, radioactive iridium wires are automatically and remotely loaded into the already placed needles.

 

BrachymSelLDRBritta.tif.jpg

Just the same as with the Selectron LDR, developed by Nucletron in 1978, the microSelectron-LDR allows the treatment to be temporarily interrupted for visitors or nursing staff at the bedside. This happens automatically when the door of the treatment room is opened. The atmosphere around the treatment is more relaxed and less intimidating than before.  For nursing staff and physicians, this means an end to working around "radioactive" patients.

The radiation unit is fitted with a computer system into which the radiation technique for the individual patient is programmed. The number of channels through which the radioactive wires are transported together with the total irradiation time are checked and registered. After the machine is connected to the needles in the breast, personnel leaves the room and the treatment is started from outside.

 

Bronnen & Publicaties

  • [64] “Ruim 30 jaar radiotherapie. Van Blokjes stapelen naar Image Guided Therapy” Farewell lecture by H. Bartelink, nov 2007. Medische oncologie nr 5. P17-19. ,