For breast cancer patients with busy lives, minimizing the length, toxicity and after effects of cancer treatment is an important part of the equation. The Radiation Oncology Department at Saint Barnabas Medical Center stays at the forefront of new therapies that maximize the cure while minimizing many of the discomforts associated with cancer treatment.

“Breast cancer is not treated the same way in every woman,” says Alison Grann, M.D., attending radiation oncologist at Saint Barnabas Medical Center. “There can be variations in patients and our individualized approach is the best way to deliver care. Because this is an academic practice, we are up-to-date on the current standards of care as well as the results of new patient studies. We perform the best, most current treatments.”

Unique Treatment for Larger Breasted Women
Radiation to the breast may cause inflammation, swelling, redness and discomfort. Patients with large breasts pose a challenge because, as breast size increases, the radiation dose may not be distributed evenly throughout the breast.

Dr. Grann says this may result in “hot and cold spots” during treatment, with the hot zones causing the breast to look less cosmetically pleasing afterward.
Saint Barnabas Medical Center is one of the only Radiation Oncology Departments in New Jersey that delivers treatment to larger breasted women in a prone position (lying on the belly with the breast hanging down).

Treatment administered while the patient is in the prone position can minimize the problem of irregular dosing within the breast, improves dose distribution and decreases the dose delivered to the heart, lung and chest wall.

“The prone position results in dramatically better cosmetic outcomes for large breasted women,” says Dr. Grann.

Intensity Modulated Radiation Therapy
In select patients, Intensity Modulated Radiation Therapy (IMRT) can minimize the dose delivered to the heart, lungs and chest wall, says Dr. Grann. IMRT delivers precise radiation doses within the breast by using computerized treatment and intensity-modulated radiation beams.

With conventional radiotherapy of the breast, the breast contour is outlined and the dose is prescribed. However, some women have breasts with more irregularities than others do, says Dr. Grann.

IMRT uses a new approach where very small beams with varying intensities are aimed at a tumor from many angles.

The radiation dose can be made to bend around important normal tissues in a way that is impossible with traditional radiation techniques. The intensity of each beam is controlled, which limits radiation to normal tissues. Computed tomography (CT) and magnetic resonance imaging (MRI) scans provide the necessary three-dimensional model of the breast.

“This treatment maximizes long term outcomes by delivering the dose in a homogeneous fashion,” says Dr. Grann.

MammoSite Reduces Treatment Time
Most cancer recurrences in the breast occur at or near the lumpectomy site, raising the question of the need for whole breast irradiation and providing the rationale for delivering radiation to the lumpectomy site alone in some patients with early-stage breast cancer.

New MammoSite treatment at Saint Barnabas allows a select group of patients to receive a more targeted internal form of radiation to a smaller portion of the breast. A thin catheter with a balloon on the end is placed into the cavity created by the lumpectomy. The balloon is inflated and then a radioactive “seed” attached to a wire is threaded through the catheter into the balloon, where it remains for only a few minutes until the wire is withdrawn. This allows a high dose of radiation to be delivered twice a day for five days on an outpatient basis.

“This treatment can be delivered over a shorter period of time, which improves quality of life for patients,” says Dr. Grann. “The inconvenience associated with a six-week course of radiation therapy is sometimes a deterrent to patients who might consider breastconserving therapy.”

Patients are generally age 70 and over with small cancers and no positive lymph nodes.

An Expert Team
Radiation Oncology at Saint Barnabas, led by Robert Goodman, M.D., Chairman; Andrew Zablow, M.D., Vice Chairman; Alison Grann, M.D., and Raquel T. Wagman, M.D., operates one of the largest cancer treatment programs in northern New Jersey and is a regional referral center. Prior to joining the staff at Saint Barnabas, our physicians were on the staff of Harvard and the University of Pennsylvania (Dr. Goodman) and Memorial Sloan-Kettering (Drs. Grann and Wagman). Dr. Zablow has dedicated his entire career to the patients at Saint Barnabas.

The Department of Radiation Oncology consists of a staff of board-certified radiation oncologists, physicists, dosimetrists, radiation therapists and nurse specialists. The Department maintains a one-year program in radiation therapy technology, one of only two such programs in the state. The Department, which has a separate entrance to the hospital and provides free parking, accepts virtually all insurance.

For more information, please call (973) 322-5630.