“Dr. Ivanov gave me the choice to choose my breast cancer treatment plan. I feel so fortunate to have had the option to receive IORT.” – Betty Rauenzahn, first patient treated with IORT at Celebration Health
The May 2012 issue of Florida MD introduced the Central Florida medical community to the new Comprehensive Breast Health Center located at Florida Hospital Celebration Health. The center, located at the 172-bed, state-of-the-art facility in the town of Celebration, is now celebrating its one year anniversary of ‘treating the mind, body and spirit’ of patients from Osceola, Orange, Polk, and Lake counties, in addition to visitors from around the world.
Under the leadership of Medical Director Olga Ivanov, MD, FACS, a board certified and fellowship-trained breast surgeon, the Comprehensive Breast Health Center quickly and effectively established a multidisciplinary approach to addressing the ‘whole-body’ implications of breast cancer. This eleven person force aligned a Pathologist, Radiologists, Medical Oncologists, Radiation Oncologists, Plastic Surgeons, Nursing and Genetics Teams, Patient Navigators, Dietitians and Exercise Physiologists. Collectively, this comprehensive unit provides a full range of care to combat breast cancer through a diagnosis, either identified onsite (through abnormal mammograms) or through referring associates at area imaging centers, primary care physician offices, and Obstetrics and Gynecology practices.
“Patients are consumed with fear when they hear the words – ‘breast cancer.’ I strive to ease their worries by educating my patients on the choices available for their breast cancer treatment,” describes Dr. Ivanov. Thankfully, with early detection (breast cancers categorized as stage 0, I and II) accounting for approximately seventy-seven percent of her patient population, Dr. Ivanov says innovative treatment plans to deliver optimum lifesavings results are possible. Nearly seventy percent of patients diagnosed with early stage breast cancer select a lumpectomy, a breast conserving surgery, combined with radiation. Others proactively select a full mastectomy for removal of the entire breast tissue containing a tumor or cancerous cells.
Following a lumpectomy, patients have traditionally been advised to undergo six weeks of radiation therapy. The process can often be stressful on the physical and emotional health of the patient and loved ones. Consequently, up to one-third of patients neglect to fulfill their radiation treatment plan, according to Dr. Ivanov. “Unfortunately the health of these women can then be compromised. Thirty-five to forty percent of such patients who do not complete their radiation regimen experienced a reoccurrence of breast cancer, compared to the possible five percent of those who did complete treatment,” explains Dr. Ivanov.
Dr. Ivanov says that a cutting-edge treatment approach called Intraoperative Radiation Therapy (IORT), currently under clinical trial* at Celebration Health, will help eliminate such concerns surrounding patients’ lack of radiation follow through. IORT is a relatively new cancer treatment technique in the United States, performed at only about twenty sites nationally; yet European countries have successfully utilized the advanced technique for about a decade. Dr. Ivanov was among the first breast surgeons in the country to explore clinical trials surrounding the usage and effectiveness of IORT in patients diagnosed with early stage breast cancer. While practicing at Little Company of Mary Hospital in Chicago,
Dr. Ivanov and her former Radiation Oncologist colleague, Adam Dickler, MD, completed a clinical study with data gathered over a four year period with seventy-five patients. Dr. Ivanov says during this time period of the clinical trial, she would begin the surgical procedure with removal of the cancerous tumor/tissue. Then, the radiation oncologist would administer the Intraoperative Radiation Therapy during the surgical procedure. A high dose of radiation was delivered within just minutes directly into the affected tissue area. According to Dr. Ivanov, since higher, yet tolerable, radiation dosages are delivered directly into the cancer bed, healthy tissue is shielded from exposure; hence a potentially safer application for other organs compared to traditional radiation treatments.
“With IORT, we radiate the area around the lump after removing it, but before closing the incision,” said Dr. Ivanov. “It gives women one dose of radiation which controls their tumor recurrence as effectively as a six week treatment of daily radiation therapy,” based on results of previous clinical trials.
The results of the clinical trial conducted at Little Company of Mary Hospital under Dr. Ivanov’s medical direction were published in Annals of Surgical Oncology. This past month at the Comprehensive Breast Health Center at Celebration Health, Dr. Ivanov began another Intraoperative Radiation Therapy (IORT) clinical trial.
“We already know the technique works; i.e. great outcomes are achieved for patients receiving Intraoperative Radiation Therapy over the past ten years (mostly reported in Europe) as stated in the literature. For our particular study, we are using a type of device called the Xoft Axxent®. It is designed to simplify the radiation therapy procedure,” says Dr. Ivanov. Florida Hospital Celebration Health is the third of seven sites enrolled thus far in this particular IORT clinical trial, with the other locations in Arizona, California, and Tennessee. The study aims to enroll 1,000 eligible patients who will be treated with IORT at up to over fifty sites nationwide and monitored post-surgery for ten years.
“The first step is educating my patients on all care options, which might include the use of IORT, currently under clinical trial only. If eligible, they decide if they want to participate in the IORT trial. The next step is a patient consultation with Dr. Michael Montejo, our radiation oncologist,” explains Dr. Ivanov. Patients are then scheduled quickly for surgery. Dr. Ivanov says after the removal of the tumor in the breast during surgery, lymph nodes are biopsied immediately. If the lymph nodes are clear, IORT can be administered instantly. Patients are typically discharged that same day and will not require additional radiation. However, if the lymph nodes are found to contain cancerous cells, patients are ineligible for IORT and would instead require a weekly radiation therapy regimen.
The summer plans of Betty Rauenzahn, a 72-year-old Orlando resident, were derailed after she received a diagnosis of stage I breast cancer. Rauenzahn says with no family history of breast cancer, she was shocked to learn she had a cancerous tumor in her right breast.
“Thankfully, it was by chance that I was referred to Dr. Ivanov for care. She kindly explained my choices and I did not hesitate to opt for a lumpectomy combined with the intraoperative radiation therapy. It simply was a better choice for my physical and mental health. Of course, I was eager to move forward with the process and my surgery was immediately scheduled for just a week out,” says Rauzenzahn, a mother of five, grandmother to fourteen, and great-grandmother to six children. On August 17, 2012 she arrived for surgery around 5:30 a.m. for procedure preparations and soon underwent a lumpectomy.
“Though I opted for IORT, I truly wouldn’t know if I received it until I awoke in recovery because they need to test lymph nodes during the tumor removal,” says Rauzenzahn. Fortunately, after Dr. Ivanov removed the cancerous tumor, a biopsy confirmed that her lymph nodes were in fact clear; thus, Betty Rauenzahn became the first patient at Florida Hospital Celebration Health to be enrolled in the Xoft Axxent® IORT clinical trial. She was discharged at 2:30 p.m. that same day and says she had no pain.
After a successful lumpectomy and IORT treatment, Dr. Ivanov says she will follow her patients, many of whom will take anti-hormone medication, closely with bi-annual checkups for the first two years post-surgery and annual exams thereafter. The reoccurrence is expected to be less than five percent in patients.
“I can’t express how grateful I am to Dr. Ivanov, Dr. Montejo, and their remarkable team for saving my life and with such ease. The Comprehensive Breast Health Center is definitely making care better for their breast cancer patients, and I hope this advancement will soon impact treatment of other forms of cancer to benefit more patients,” expressed Betty Rauenzahn.
“Patients who receive IORT can never truly understand the benefits of this procedure because they are fortunate to bypass the intensive and demanding cycles of traditional radiation therapy,” says Dr. Ivanov. Rauenzahn confirms, “The world of my friend who is battling breast cancer is completely consumed with daily visits to radiation, which is taking a harsh toll on her. I am so blessed to have avoided that inconvenient process, thanks to Dr. Ivanov, Dr. Montejo, and the other physicians and nurses who participated in my care.” Dr. Ivanov and Dr. Montejo have since enrolled and treated additional patients in this IORT clinical trial.
Already a visionary in treating breast cancer patients, Dr. Ivanov says she plans to begin development of a new High Risk Breast Cancer Screening Clinic, specifically aimed to help women identify their genetic and environmental risk of acquiring breast cancer. A key objective of the clinic will be to educate the community about breast cancer risk factors. Some of these risk factors include: family history of first degree relatives who were diagnosed with breast cancer (mother, sister, or daughter – especially if diagnosed at 50 years of age or younger), family history of ovarian cancer, young onset of menses and/or late onset of menopause, and a history of certain proliferative breast lesions with Atypical Ductal or Lobular Hyperplasia and Lobular carcinoma in situ (LCIS).
“1 out of 8 women will be diagnosed with breast cancer in their lifetime. I believe we can have a great impact on the outcomes of these patients by proactively evaluating our high-risk populations,” said Dr. Ivanov. “During the months of October, November, and December, all Florida Hospital locations will offer mammograms for just $35. Typically mammograms can cost patients up to $150, which unfortunately can cause some women to skip this important screening. This discount offer illustrates Florida Hospital’s commitment to women’s health and our goal to grant mammogram accessibility to all women.”
*Criteria for participation in the IORT clinical trial includes, but is not limited to, the following protocol: females, 60 years of age or older, newly diagnosed invasive ductal carcinoma of the breast, a tumor size less than or equal to 2cm and no positive lymph nodes.
Comprehensive Breast Health Center
at Celebration Health
400 Celebration Place • Celebration, FL 34747
Phone: (407) 303-4610
Empower your patients to lead the fight against breast cancer by joining the Pink Army. These Florida Hospital foot soldiers play an integral role in bringing education, awareness and hope to the people of our community. Help recruit our
• Enlist to receive Pink Army dog tags and tool kit
• Climb the ranks with various Pink Army missions
• Impact the Florida Hospital Breast Care Fund to provide mammograms to our underserved residents
October is Breast Cancer Awareness Month
You can help save a life from breast cancer simply by reminding your patients and loved ones to do monthly self-breast exams. Share your knowledge with others:
• In 2010, an estimated 207,090 women in the United States were diagnosed with invasive breast cancer and nearly 40,000 women died from the disease. In addition, an estimated 1,970 men in the United States were diagnosed with breast cancer.
• More than 11 million Americans who have a history of cancer will celebrate another birthday this year.
• More than half of all cancers could be prevented with risk reduction/healthy lifestyle choices.
– Facts provided by the American Cancer Society