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Medical Forum / Diseases and Disorders / Breast Cancer / December 2004

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Laser Lumpectomy?

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richreilly@hotmail.com - 12 Dec 2004 01:00 GMT
I came across some articles from late 90s as well as a site that says
they are using lasers for breast surgery. Supposedly a number of
advantages. Anyone know about this?

"Laser Lumpectomy Leaves No Scars
A new non-invasive technique combining interactive magnetic resonance
imaging (MRI) and fiber optic laser delivery has shown promise in
locating and ablating cancerous breast tumors. Researchers at the
University of Arkansas for Medical Sciences developed the procedure,
which could offer a percutaneous alternative to surgical lumpectomy and
thus reduce the likelihood of scars or disfigurement in patients with
confirmed cancer.
"Treating breast cancer has always been a struggle between
obtaining local control of the tumor and providing the best possible
cosmetic result," said Dr. Steven Harms, director of the research.
"This will allow us to provide the ultimate in breast conservation with
almost no sign of the treatment."
He added that the technique offers a favorable cost advantage over
mastectomy procedures, a benefit that is not realized by current
lumpectomy methods, which usually entail subsequent radiation
treatment.

Interactive MRI
Harms' procedure uses interactive magnetic resonance to find the
tumor and guide a needle into the cancerous tissue. The doctor feeds a
fiber optic wire down the needle and uses an 805-nm laser from Diomed
Ltd. of Cambridge, UK, to char the tumor at 25 W for three seconds. The
laser energy is reduced to 3 W for more than eight minutes to ablate
the tumor. Harms said it is possible to split the optical fiber into
four fibers and thus bypass the charring step.
The enabling technology behind Harms' method is a computer software
adaptation of standard magnetic resonance imaging technology called
Rodeo MR (Rotating Delivery of Excitation Off-resonance). This
interactive MRI technique, which is still in clinical trials, allows
doctors to accentuate the contrast of breast tissue to distinguish
exactly where the tumor ends.
Harms' study examined 15 patients who were scheduled to receive
surgical cancer treatments following the laser lumpectomy. Tissue
analysis from these subsequent surgeries confirmed that in each case
the laser technique had successfully eliminated the targeted tumors.
Harms next plans to treat patients using only his laser technique,
without surgical treatments. He estimates that this phase of research
will take five years to determine whether the cancer recurs. "

A current site promotes laser as more of a better version of scalpal
surgery
richreilly@hotmail.com - 12 Dec 2004 01:42 GMT
more..current:
Landmark Breast Cancer Pilot Study at UAMS Examines New Breast
Conservation Therapy

LITTLE ROCK - The University of Arkansas for Medical Sciences (UAMS),
and RITA Medical Systems, Inc. (Nasdaq: RITA) today announced that the
first patient in a planned series of 30 received a radiofrequency
ablation-assisted lumpectomy procedure.

The RFA procedure, which sears a one-centimeter margin, or perimeter,
of soft tissue following standard lumpectomy removal of a breast tumor,
is intended to give the patient a cancer-free area around the site
where the tumor has been removed so that repeat lumpectomies and/or
radiation therapy are unnecessary.

V. Suzanne Klimberg, M.D., professor of surgery and pathology at UAMS,
developed the procedure being used in the clinical study, "Pilot
Study of Radiofrequency Ablation of Breast Cancer Lumpectomy Sites with
Indocyanine Green Confirmation to Decrease Re-operation."

"Our goal is to change the way breast cancer is treated for the more
than 100,000 women in the United States who undergo traditional
lumpectomy for early stage breast cancer each year," Klimberg said.
"Our initial research on donor mastectomy sections in the lab told us
that RFA was effective in creating negative margins around small breast
tumor."

Klimberg also is chief of the Division of Breast Surgical Oncology at
UAMS, director of the Breast Cancer Program in UAMS' Arkansas Cancer
Research Center (ACRC) and staff physician the Central Arkansas
Veterans Healthcare Systems (CAVHS).

"With the study we hope to prove that we can reduce the high
re-operative rates associated with lumpectomy and that we can reduce
the need for whole-breast radiation therapy following surgery to remove
a breast tumor," she said.

Klimberg will treat up to 30 patients in the clinical trial. The
treatments will be performed under the guidelines of the pilot study
approved by the investigational review board (IRB) with educational
funding support provided in part by RITA Medical Systems of Mountain
View, Calif. Additional support for the study will be provided by the
Tenenbaum Breast Cancer Research Program.

The researchers believe that giving patients a clear surgical margin at
the time of the original lumpectomy will make unnecessary the estimated
40 percent of repeat lumpectomy procedures currently being done. The
researchers also believe that the need for a standard course of five to
six weeks of whole-breast radiation therapy may be reduced or
eliminated for some patients who receive RFA-assisted lumpectomy.

"We are honored to partner with the University of Arkansas for
Medical Sciences and its Arkansas Cancer Research Center and are
pleased to support Dr. Klimberg's efforts," said Joseph DeVivo,
president and chief executive officer of RITA Medical Systems. "We
believe the procedure holds great promise for breast cancer patients,
and we are proud that RITA's current RFA offering is Dr. Klimberg's
product of choice."

Under the IRB-approved prospective trial protocol, qualified patients
will be treated with RFA at the time of initial lumpectomy. Before and
after RFA is completed, fluorescence imaging will be used to ensure
that no residual live cells remained in the ablation zone. Patients
will be required to come in for follow-up visits at set intervals for a
minimum of two years after the procedure. Although local recurrence
rate is not the primary aim in this pilot study, patients still will be
followed over time for local recurrence.

Each year in the United States, an estimated 120,000 women receive
standard breast conservation therapy, commonly referred to as
lumpectomy. Of these patients approximately 40 percent require
additional surgery when pathology, typically reported two to five days
following initial surgery, reveals the presence of cancer in the margin
surrounding the tumor.

Also, only 10 percent to 40 percent of patients who are candidates for
breast conservation therapy are receiving it, indicating the majority
of women are undergoing some form of mastectomy (surgical removal of
the whole breast), although several studies demonstrate equivalent
outcomes for lumpectomy plus radiation therapy (RT) compared with
mastectomy. Mastectomy also can result in significant psychological
effects.

Whole-breast radiation therapy is recommended to most patients
following lumpectomy to reduce the risk of recurrence at the surgical
site. RT is associated with substantial side effects during treatment,
as well as late toxic effects and significantly decreases patient
quality of life.

Another motivation to develop an alternative to RT is the number of
patients who refuse to be treated with RT following lumpectomy.
Estimates suggest that 30 percent to 40 percent of breast cancer
patients choose not to receive RT due to fear about side effects and
poor cosmetic results, and concerns about consequences of travel and
impacts on their job or family. Radiation is typically given five days
a week for five to seven weeks.

Breast cancer remains the leading cancer diagnosis in women in the U.S.
and will affect one in seven women in a woman's lifetime, with more
than 215,000 new cases estimated to be diagnosed in 2004. About 59,000
more women will be diagnosed with a very early stage of the disease.
Despite availability of breast-conserving surgery, only 10 percent to
40 percent of women in the United States who are candidates for this
treatment receive it.

Approximately 185,000 women diagnosed with early-stage breast cancer
undergo one of the three most common surgical treatments: lumpectomy,
lumpectomy with radiation or mastectomy. Each of these treatments is
associated with a range of potentially negative physical and
psychological effects, including cosmetic effects, toxicity and
considerable risk of recurrence. RFA-assisted lumpectomy may allow
improved cosmetic results with the best opportunity to ensure negative
margins in patients with early-stage breast cancer, while avoiding the
adverse effects associated with radiation therapy.

RITA Medical Systems develops, manufactures and markets innovative
products for cancer patients, including radiofrequency ablation (RFA)
systems for treating cancerous tumors as well as percutaneous vascular
and spinal access systems.  The company's oncology product lines
include implantable ports, some of which feature its proprietary
Vortex® technology; tunneled central venous catheters; safety infusion
sets and peripherally inserted central catheters used primarily in
cancer treatment protocols.  The proprietary RITA system uses
radiofrequency energy to heat tissue to a high enough temperature to
ablate it or cause cell death.  In March 2000, RITA became the first
RFA company to receive specific FDA clearance for unresectable liver
lesions in addition to its previous general FDA clearance for the
ablation of soft tissue.  In October 2002, RITA again became the first
company to receive specific FDA clearance, this time, for the
palliation of pain associated with metastatic lesions involving bone.

UAMS is the state's only comprehensive academic health center, with
five colleges, a graduate school, a medical center, five centers of
excellence and a statewide network of regional centers. UAMS has about
2,170 students and 650 residents and is the state's largest public
employer with almost 9,000 employees. UAMS and its affiliates have an
economic impact in Arkansas of about $3.8 billion a year.

UAMS centers of excellence are the Arkansas Cancer Research Center,
Harvey and Bernice Jones Eye Institute, Donald W. Reynolds Center on
Aging, Myeloma Institute for Research and Therapy and Jackson T.
Stephens Spine and Neurosciences Institute.
 
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