The Breast Program at the University of Arizona Cancer Center is staffed by dedicated specialists who are uniquely suited to provide for your individual needs. Our experts provide state-of-the-art breast cancer treatment with a compassionate and connected approach.
At UACC, we strive to provide complete care through our integrated breast cancer team. Breast cancer is diverse. Some patients can safely be treated with surgery alone. Others patients may benefit from up-front chemotherapy, surgery and then radiation. Deciding which approach is best in your situation requires a closely knit team of specialists who understand the entire treatment process and have access to all of the available treatment options.
Victor Gonzalez, MD. Dr. Gonzalez is a board certified radiation oncologist who specializes in breast cancer treatment. He works closely with all of the members of your breast cancer team to tailor treatment your needs.
Why so specialized?
Each member of the UACC breast cancer treatment team is exclusively dedicated to treating patients with breast cancer. In the rapidly changing world of breast cancer research, this specialization allows our doctors to provide cutting edge care to every patient, every day.
Special techniques for breast radiation
The UACC breast cancer team offers a diverse array of advanced technologies and treatment techniques specialy suited for breast cancer. This variety of options allows us to offer the treatment that is right for you. Special radiation techniques include accelerated partial breast irradiation and various forms of external radiation therapy.
Special radiation techniques include the following:
- Heart protection with breathing sychronized radiation treatment: The Varian® Real-time Position Management (RPM) system allows for radiation to be delivered at specific phases of the breathing cycle. Using an infrared camera, the system is able to track the patient’s respiratory pattern. Video goggles provide the patient with a real-time graph of her respiratory cycle. Coupled with the imaging and treatment equipment, the RPM system electronically triggers the radiation beam only when the patient is breathing in deep enough for the heart to be out of the radiation field.
- Short-course whole-breast radiotherapy: Breast radiotherapy in the United States has traditionally been given once a day over 5-7 weeks. In other countries, shorter courses of 3-4 weeks have been routinely used. These two approaches have been compared in research studies. The long-term (>10 year) follow up from these trials has demonstrated that a shorter course of radiation is as effective and safe as the traditional course. Short course radiation is usually an option when the lymph nodes are not being treated.
We are currently enrolling patients on the RTOG 1005 trial. This is an international study which is investigating a shortened (15 treatment) course of radiation to a longer (22 treatment) course.
- Intensity modulated radiation therapy (IMRT): This is a type of external radiation therapy. In IMRT the dose of radiation coming from different parts of the radiation field is adjusted. In this way, the dose to the breast can be smoothed out depending on your anatomy. All patients receiving breast radiation at UACC receive some form of IMRT.
- Segment weighted tangent IMRT: This is the most frequently utilized form of breast radiation at our center. With this technique, two opposing radiation beam angles are used to treat the breast. The angles of the beams is chosen to avoid exiting through the heart or lung. Each beam is then divided into 10 to 20 smaller beamlets. This allows the radiation to evenly deposit throughout the breast tissue regardless of the shape or size of the breast.
- Multifield IMRT: In multifield IMRT, numerous different beams are selected to cover the breast tissue or lymph node regions. This includes beams that are exiting through healthy tissues like the heart, lungs, and other breast. The treatment planning computer adjusts the dose of radiation going through each part of each field to come up with a plan that meets all of the constraints set by the physician. This technique is very effective at shaping high doses of radiation but ends up exposing more normal tissues to low doses of radiation.
- Helical Tomotherapy: This is a special form of IMRT in which the radiation source rotates completely around the patient. Because of the special shielding used in the machine, very little radiation leaks out to surrounding tissues. Tomotherapy is well suited for the treatment of left breast cancers following mastectomy.
- Accelerated Partial Breast Irradiation (APBI): Sometimes, the area immediately around the original tumor site is the only area at significant risk for recurrence. In this case, radiation may be targeted just to the cavity. This is known as partial breast irradiation. Since only a small volume of tissue is targeted, larger doses of radiation can be given. This allows for fewer radiation treatments to be given.
A shortened course of radiation targeting only the surgical cavity is referred to as Accelerated Partial Breast Irradiation (APBI). Typically, APBI is given over five days with two treatments given per day, with treatments at least 6 hours apart. The radiation dose given with each fraction of APBI is higher than the doses used for whole breast radiation. Partial breast radiation is generally only used as the stand-alone radiation treatment in women with small tumors that have not spread to the lymph nodes.
There are several different ways of performing APBI. The most common technique is with the use of a special balloon catheter. A small saline-filled balloon is placed in the surgical cavity within the breast. This balloon has a hollow tube attached to the center. This tube runs through the breast tissue and through an incision in the skin. When you come in for treatment, the tube is connected to a special machine. This machine contains a tiny radioactive pellet on the end of a cable. The radioactive pellet is pushed through the tube into the balloon inside the surgical cavity. The pellet remains in the balloon until the correct dose of radiation has been deposited. When the treatment is complete, the machine pulls the radioactive pellet back into a shielded container. The catheter is then disconnected. There is no radioactivity left behind after the procedure. After the final treatment, the balloon is deflated and the tube (with the balloon attached) is pulled out of the breast through the incision in the skin. The incision heals over a few weeks’ time.
At UACC, we offer partial breast radiotherapy using balloon based catheters (Mammosite, Contoura), as well as with the SAVI device.
- Brachytherapy (internal radiation)
- External beam radiation
- Stereotactic Radiosurgery/ Stereotactic Body Radiotherapy: This is a precise form of treatment in which very high doses of radiation are given to a small area. In stereotactic radiotherapy, the tumor is targeted from multiple beam angles. All of the radiation beams meet at the tumor. In this way, the dose of radiation coming in through the normal tissues can be kept to safe levels while delivering a very high dose within the tumor itself. Stereotactic radiotherapy is often given as a single treatment for a tumor that has spread to the brain. In this case, it is referred to as Stereotactic RadioSurgery (SRS). There are numerous different types of machines capable of performing stereotactic radiotherapy.
At UACC, Stereotactic RadioSurgery is performed with the Novalis treatment system. This platform allows for the shape of the radiation beam to directly fit the tumor from nearly every angle.
Commitment to Safety
Patient safety is our number one concern. The University of Arizona takes pride in our active team of medical physicists dedicated to the accuracy and safety of each patient’s treatment. Our physics team leads and maintains a stringent quality assurance program, which surpasses national standards. This program aims to ensure that all equipment is maintained in top condition, and that individual patient treatment is of the highest quality.
Prior to start of any treatment, the physics team carefully checks all aspects of the patient’s treatment plan and performs complete measurements to ensure that the radiation will be delivered as desired. On each treatment day, safety interlocks and equipment calibrations are tested and verified. Additionally, the physicists perform regular checks and measurements throughout the treatment course to ensure that each patient is receiving the correct care.
As an academic institution, The University of Arizona has the advantage of physicists who are leaders in their field. With the only medical physics training program in the Southwest, our physicists commit to teaching and research, with goals to continually improve each patient’s care. We also have the advantage of leading edge equipment and technology available, with regular training for our highly skilled staff.
The University of Arizona Cancer Center offers numerous opportunities to participate in clinical trials. The Department of Radiation Oncology has two full-time research coordinators who help guide you through the process.