As far as Dr. Rick Hudes is concerned, progress is progress. And in medicine, he says, even incremental improvements can be monumental.
That’s why the chief of radiation oncology at Saint Agnes Hospital in Baltimore chose to install a relatively new and uncommon technology for delivering radiation treatments to breast cancer patients.
Known as AccuBoost, the system is supposed to be safer and more effective than traditional methods — but perhaps only modestly so, and the improvement is hard to quantify, Hudes said.
Hudes is confident AccuBoost was a worthwhile investment, but he said the scarcity of concrete evidence is probably why Saint Agnes is, so far, the only Maryland hospital that uses the technology, which was developed by a small Massachusetts firm.
Here’s how it works: When a woman gets a lumpectomy, she typically undergoes several weeks of radiation to keep cancer cells from spreading to surrounding tissue. This is typically done in one of two ways, but both have drawbacks, such as burns on the skin and “scatter” radiation that can hit healthy organs.
AccuBoost offers a third option. Using a mammography machine to compress the breast, the AccuBoost system comes with “applicators” that deliver a much more precise dose of radiation to the targeted area. The applicators, made of extremely heavy-duty metal, direct the radiation exactly where it’s needed — and away from where it’s not.
With regular radiation therapy, a beam of “electron” radiation is directed at the woman’s body like a flashlight. It doesn’t penetrate very far, Hudes said, “but some does get in.”
“There’s no major known problem with that, but especially for left-sided breast cancers where the heart could be right behind the breast, you’re talking about incremental doses with unknown risk. So, in terms of scatter dose, the less the better.”
With AccuBoost, “the beam is never coming directly at the woman’s body, so you end up with much less scatter,” Hudes said. “You’re also spreading out where the dose hits the breast, so you’re sparing the normal tissue from the radiation.”
The traditional way is safe, Hudes said, “but AccuBoost is better.”
Some oncologists might disagree.
“This is a subjective improvement that you can’t really quantify, because there’s no known data about the negative effects of scatter radiation,” Hudes said.
Then there’s the capital investment. The system cost about $400,000 to install, plus a few thousand dollars in occasional maintenance expenses. AccuBoost is more expensive than the prevailing methods, but Hudes said he thinks it’s still covered by most insurance plans.
Another challenge is staffing. The system requires both a physician and a medical physicist to be present for each treatment, which can be difficult to provide, Hudes said.
“I think the Achilles heel of this technology is that it requires both those staffers to be present,” Hudes said. “I think that’s going to be what keeps it from getting into many facilities.”
At Johns Hopkins Hospital, officials have followed the AccuBoost system with great interest but have chosen to pursue a different technology, said Dr. Jean Wright, assistant professor of radiation oncology at Sibley Memorial Hospital, a Hopkins affiliate.
Sibley uses an interoperative radiation therapy during partial breast surgical procedures that also serves, as does AccuBoost, to provide a “boost” of additional treatment, she said.
Wright said there have been very positive reports about the efficacy of the AccuBoost treatment but that, as with any new procedure, the results need to be thoroughly studied.
Ray Bricault, the chief operating officer of Advanced Radiation Therapy, which created AccuBoost, stressed another point about the treatment.
“When you look at studies about the complications for breast radiation therapy, they conclude that the more tissue exposed to a higher dose, the more complications you have,” Bricault said. “So anything you can do to reduce that exposure is going to reduce long-term [complications] of the procedure.”
Since it was unveiled seven years ago, AccuBoost has been gradually cropping up in hospitals nationwide. It’s now used in 53 centers, and more than 4,000 patients have been treated, Bricault said.
Brenda Afzal is one of those patients.
Afzal, a retired nurse, had no room in her schedule for breast cancer. She was diagnosed in December of last year, but had already paid for a big family vacation to the Caribbean — in February. She hadn’t bought trip insurance.
“Everything would be lost,” Afzal said. “So I said to Dr. Hudes, ‘I’m on a timeline here. I want to move fast.’ He told me about AccuBoost, which could speed up my course of radiation. And it was also really encouraging because it could spare my heart, lungs, ribs and other things.”
Afzal underwent surgery, completed the AccuBoost treatments and went right into five weeks of traditional radiation, which is often still required.
The treatment was over just in time; her plane departed four days later.
So, how was her vacation?
“Well,” she said, “I wore rash guards instead of a teeny-weeny bikini, but oh, it was so glorious!”