Lumpectomy & Radiotherapy 'one' day combined operation : TARGIT IORT (Intraoperative Radiotherapy Treatment).

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Dear All,

Firstly, a massive 'Thank You' to all that helped me at the start of my journey - you are all amazing people, I don't know where I would be without your support and I mean this, London Lass, toxophilite, Dreamthief, Snowys Mum, Heather77, Optimistic, mrsox, wombat.23, sue G, scared_2, Tzxy, Mistymoley, Pocket rocket, Indigo67, Mirabo, just mentioning a few of you, you have helped me more than you will ever know - you understand it, the worry, the down's, the tears, the tantrums, question after question, the through the night 'AWAKE' club - 'Thank You All'.

I wanted to give you an update on "What Happened" to me (hence my name on here) and for anyone new considering 'all treatment options'.  I had a totally un-expected and soul destroying diagnosis of Breast Cancer...... all because of a very small 'dimple' (not a lump), a dimple on the outside of my left breast, at say 2.00 o'clock position.

My diagnosis: Ductal Breast Cancer - Grade 1, NST (Non Specific Type) 20mm diameter, ER8 positive - I don't have to tell you about the shock, the terror and feeling of total devastation that came over me.  So what do we do, I like most of us here, jumped straight onto the internet and, thankfully find this website, we read and re-reading other ladies and gentlemen stories, we slightly start to calm down.  I joined this forum and have met some of the most amazing, kind, caring, understandable ladies ever - people that I have never met gave me more hope, strength and guidance, more than lifelong friends and even family.  For this I am truly and eternally grateful to you all, I really am.

My suggested treatment: would be Wide Local Excision plus sentinel lymph node biopsy, followed by, 3 to 4 weeks External Beam Radiotherapy treatment (EBRT) and, then either 5 or 10 years of adjuvant treatment (daily tablet). I am given the date of 3rd October, for my operation.

My research: Whilst waiting for my operation I began to 'look into various treatments'.  My BC was on my 'left side', I start reading that external beam radiotherapy could be dangerous to the heart, maybe even the lungs, I am on the roller coaster ride, the various waves of emotion - all the questions, the 'what if's', etc. I start looking into this more, I find that there are ways to help avoid this by doing 'deep breath-hold' during radiotherapy treatment, I carry on looking, I then come across a treatment called 'Deep Inspiration Breath-Hold Radiotherapy' which is an effective method of limiting radiation exposure to the heart and lungs.  This now sounds more reassuring to me, it is given externally over the same time frame between 3 to 4 weeks with I believe at boost at the end of the treatment.  This option was only available privately to me and I made enquires, this looks like the way I will go.  During the night times I continue with my research.  I do believe 'fate' took over from here.  Due to my worries and uncertainties, I am going to delayed my operation.

For me and I think for most of us at the time we are diagnosed we are literally thrown in to a feeling of 'total and utter despair, what our future holds, what future, are our lives about to be taken from us' - most of us go with 'what we are told' until, that is we join a forum such as this, we then see we are not alone, there are others here, others here willing to help us, advice us, guide us and support us - some may recall one of my initial posts after the shock was two different views on what operation I should be having the 'Wide Local Excision' or the 'Therapeutic Mammoplasty' - I had one particular response that was brilliant and it has stayed with me. I didn't go for the therapeutic mammoplasty (suggested by a different Consultant) - smaller boobs appealed to me, but, I couldn't justify putting myself through this if there was no need).

Back to my story, if anyone is still reading this....

I delayed my operation whilst I took time to looked into the radiotherapy treatments.  I found one, if I was suitable, it sounded amazing, a 'one off' radiotherapy treatment given 'internally' directly focused on where the BC had been.  It is given at the 'same time' as the operation, whilst under the same anaesthetic!!  I looked into this, it is called TARGIT IORT (Intra Operative Radiotherapy Treatment).  A 'one -off' treatment!!! it sounds fantastic, it does away with the weeks of daily travelling to and from the hospital for treatment, it avoids the possible damage and burning to the outside skin and avoids the heart and lungs. 

TARGIT IORT - Targited Intra-operative Radiotherapy; is a radiotherapy treatment given at the 'same time' as lumpectomy/operation.
It is a 'one-off' internal treatment of radiotherapy - although some patients could need traditional external radiotherapy dependant on results of the tumour.
It is only suitable for certain types of BC treatments, including women 45 or older with hormone receptor positive, tumour size up to 3.5cm. It is not suitable if needing a mastectomy. Something else that many might not know, we can only have 'external' radiotherapy treatment 'once'.  This is not the case with 'internal' radiotherapy, you can have additional radiotherapy treatments plus external too.

This really sounded to good to be true, I looked into this, I fit the criteria, I looked at all the questions I had, all the 'for's and 'against', all the what if's". This treatment was for me, it isn't currently available on the NHS, I don't have health insurance so, I will have to pay for this treatment (please don't think the money was not an issue, it was).  

This is were my story could go on in a different direction, this treatment is within 'inches' of being available to all of us (that fit the right criteria) - NICE have come within inches of giving the approval/go ahead for TARGIT IORT .... however, they have had some appeals/objections from certain 'bodies/organisations' .... one being our very own NHS England, along with, I believe, the Royal College of Radiologists - I may post separately on this, I feel very strongly about this.  We are being denied 'greater patient choice' - the NHS England should routinely mention to suitable women 'all' treatment options - we are being denied this.  (The review is on the 8th December, 2017).
Patients would benefit both physically and mentally. Having a 'one-off' treatment of radiotherapy compared to 'weeks' would surely save the NHS both money and time, freeing up Radiologists and machines to treat more patients! 

So back to my story....

I contact the Secretary, she is a lovely lady, kind and understanding, she listens to me and takes all my details.
I'll fast forward a little.  I had thought long and hard about this treatment - two of my main key points of consideration on having this 'one-off' treatment of radiotherapy is....
I'm not telling my mother that I have BC - I had decided to say, I had a little 'lump' that needed to be removed.  If I have the daily radiotherapy treatment I could not of kept this a secret for so many weeks, to keep disappearing out for a few hours each day, plus my maybe irrational worries concerning the external radiotherapy treatment, so my mind was made up.

I travel to see my Consultant, he is a Professor, what a man, so kind, caring, approachable, honest and genuine. Everything is arranged for me, ultra-sound, biopsy, skin tag marker, MRI, my bloods, MRSA screening, the nuclear dye to locate my lymph node, etc.everything is all in hand.

I am given my surgery date arrghhhh Friday 13th October!!!! - I said earlier, I had delayed my original surgery, this date was the 3rd October, so, after all said and done I had delayed by 10 days. (I am superstitious - again fate played a part here, half an hour after receiving the phone call to give me the date for the operation, I happened upon an old tablet box of my late fathers with the date (wished there was emojis on here) 13th October, 1997 - okay its 20 years old!!! but, 20 years to 'the' date - pretty strange if you ask me - I now know in my head, Friday the 13th will be okay :)

This is me all over, waffle, waffle..... so cutting to the chase....

My operation; I arrive at the hospital on Friday morning:-
10.30am - I meet my Anaesthetist, a very nice man.
11.30am - I am walking down to Theatre - I am greeted by a couple of lovely ladies, I climb on a trolley and I'm covered in nice warm blankets, they talk to me and 'try' to put me at ease.
11.40am - I see my Anaesthetist, we chat, he puts a needle in my hand.
11.zzZzz - I've gone zzzzZzzzz - I must be having my surgery.

I come round in the recovery area - don't know the time and don't remember much.
3.30'ish - I am back in my room, thinking I'm with it, all the time, getting more 'with it' haha
4.15'ish - My Consultant comes to see me....

Everything went brilliant, we have clear margins, there was no spread to my lymph nodes, the TARGIT IORT Radiotherapy is all done.

My cancer is now removed and my radiotherapy treatment is all completed.

My recovery; it all went so well, I am truly blessed, I have had no pain, maybe if I try hard to moan, I could say, I had the very occasional slight, only slight twinge from where the lymph node biopsy was taken - but nothing, honestly, nothing to complain about.
I was expecting massive amounts of bruising - virtually none.  

My left breast; is now smaller than my right breast, I have a very fine 3" long scar, the area is hard to the touch (I'm told this is normal and will soften with time).  There is 'no dent' - I had expected to have a 'dent' on due to the size of the tumour.  I am over the moon.

Going forward.... from 'oww Whats Happened - to 5 weeks later I've had my operation and my treatment is finished' (apart from the daily tablets). I can't believe it and for anyone else reading this that is suitable for this type of treatment, you could have this all done in less than a couple of weeks. 

I follow most of the post on this forum and many times I have gone to write 'What Happened' and where I am now.  When I looked searched for TARGIT IORT treatment there are no posts on here, this makes me sad, maybe no one knows about this treatment or like me, at first are in such turmoil. What I do know is, I have felt very blessed to have been able to have this treatment, I have no regrets, I feel humbled and I'm not sure if this is the right words, maybe a little embarrassed that I have selfishly 'stepped outside the box' for my treatment - please don't think I have lots of money, a lot as gone into getting the money together to have this treatment - I will say, I do not regret this choice I was lucky enough to be able to take, not one bit.  
My initial treatment on the NHS was fantastic and I could not knock them - they just would not give me the two treatments combined and, as it looks they don't want it to be available to us in the future - I really hope this is not the case, this type of treatment needs to be available to all suitable woman.

For any of you still reading this, 'Thank You', I hope my experience can help xxxxx
Sending love and hugs to everyone xxxxxxxx

Ps. I am not medical qualified, these are my own thoughts anyone considering any form of treatment should make their own enquires to the various options out there. 

  • FormerMember
    FormerMember

    Hi  

    Thank you for highlighting Targit-Iort  :)

    It has to be the way forward for breast cancer radiotherapy, but as usual NICE are dragging their heels saying there isn't enough evidence as yet confirming that Iort is as good as or better than conventional radiotherapy regarding recurrence - Doh!

    How much evidence do they actually require ? There is plenty of info about Iort on the NICE website but it seems everytime it comes up for review they just keep Umming and Ahhing about it :-/

    Even though the machines are just under £500K each you would think that the savings alone would make it a viable option yet alone the well being of the patient. I assume Targit-Iort is not an option if you have any form of lymph involvement though... ?

    Incase it is an option open to others; care to mention how much this cost as a private patient ?

    Take care, G n' J

  • FormerMember
    FormerMember

    Hello

    Very pleased to hear you are doing well.  I had a similar diagnosis to you and asked about TARGIT at the time of diagnosis.  Although I sailed through radiotherapy, I would rather have had TARGIT. I feel annoyed with myself I didn’t ask now of alternative providers.  Can you give an indication of where you had your treatment?


    Also I didn’t quite follow why NHSE have turned it down, can you expand a bit or direct me to article?  Thank you and good luck.

  • FormerMember
    FormerMember in reply to FormerMember

    Hi  

    There is a raft of documents on the NICE website to have a pick through.

    G n' J

  • Really interesting account  I had never heard of this treatment. It must have been empowering to decide your own treatment and put the plan into action. Well done for taking things into your own hands xxx

    Helen
  • I think it might be best that a new discussion is created with regards to TARGIT, NICE and appeals lodged.

    NICE's initial gave provisional approval for use back in February of this year is linked below: (twitter tweet):-

    https://twitter.com/NICEcomms/status/831850566741471233,  

    The appeal panel meets "to hear oral representations from the appellants" on Friday 8 December at NICE, 10 Spring Gardens, London SW1A 2BU. 

    Below is a link to the NICE page where all the different papers, appeals are etc:-

    https://www.nice.org.uk/guidance/indevelopment/gid-tag353/documents

    I think this needs its own "discussion" for many reasons, mainly at the start of our journeys into BC unless we are in the medical world, or know someone going through BC most of us will not be aware of what is going with types of treatment, let alone 'behind the scenes'.  

    We get told limited information and, to be honest, 'did we really taking much notice of what treatments, studies, etc are out there'.
    Most of us trust the NHS and believe they 'should' routinely mention 'all' treatment options available, yet in most cases they don't.

    Hi Dreamthief - at present I can't answer concerning lymph node involvement.  I will find out and I'll update this post later.

    (My initial thoughts are: 'why wouldn't it be' - my understanding is, it may not suitable if more than one 'lump/area' is involved or if mastectomy is required. If there is lymph node involved then I think treatment would be along the lines of 'operation and TARGIT IORT Intraoperative radiotherapy treatment, followed by treatments used when lymph nodes are involved, I'm thinking certain type of chemotherapy - Like I say this is 'my thought' and I'll update once I know or if anyone else knows please feel free to add comments). 

    TARGIT IORT : this is 'targited' radiotherapy given 'internally' at the same time after the lumpectomy/operation, given directly to the area 'where' the was tumour .

    IORT = Intra-operative Radiation Therapy.

    EBRT = External Beam Radiation Therapy.

    Below is a link to a 'web-tool' that should help to check suitability for Intrabeam TARGIT IORT:-

    Click here for a web - tool to check suitability for Intrabeam TARGIT IORT

    This treatment has approval for people lucky enough to have Health Insurance. 
    Cost, anyone seeking this type of treatment would ask for their own quotation/price at the start.  

    You need to remember this cost includes the lumpectomy/operation and the TARGIT IORT, you can't have one without the other, it's done at the same time. I imagine cost would vary patient to patient, dependant on type of treatment, operation, size of tumour even (?)

    My treatment before my operation included: Blood Tests, Ultrasound Scans, MRI Scan, Ultrasound Marker Clip, Nuclear Medicine for looking at/locating Lymph Nodes, MRSA screening, Hospital Charges. Then going forward to the operation: Operating Theatre charges, Anaesthetist, Radiologist, Surgeon costs, delivery of TARGIT IORT, various Nurses, Overnight Hospital Stay, Pathology Report, any overnight accommodations, etc., plus dependant on what part of the country you live and where you opt to have your treatment, travel costs, train, car, taxis, etc., all have to be considered.  Including everything, you would looking at around £18K to £20K (you can mention my name, but, don't quote me on this) - for this you get all the above, plus within 2 weeks or less from being diagnosed your Lumpectomy/Operation and Radiotherapy treatment can be completed and finished. 

    I live in the West Midlands and choose to have my treatment in London, I was so self indulgent, I went for the best of everything - I think I was the shock, thats the excuse I gave myself, I was having the best I could, we travelled by train and may I add, the last time I had been on a train it was ran and owned by British Rail - this time I'd thrown caution to the wind and was traveling 'First Class' on the Beard'y Man's trains (you can get some amazing deals if you book in advance).  I've worked all my life, gone through a bad 7 years following the passing of my father, then we lost my mother-in-law, I've not bothered with a holiday for 7 years - so when this BC came along, this form of treatment was my present to myself - my very own, well deserved, self indulgent present to myself.  Do I regret it 'no' - of course I am sad I had to pay for it and I'm angry that it was denied to me via NHS - however, 'it is what it is' - I would not swop what I did nor the treatment choice I made. I may of borrowed a bit of money to help towards financing (it will be repaid) - for me though, mentally, physically and emotionally it is well worth it.  I hope treatment will be available from NHS England to all suitable women ASAP.

    Just an added thought before I post:-
    Another couple of things worth considering: With the internal radiotherapy treatment, you don't get damage caused to the outside skin, along with assoicated pain and soreness.  You do away with travelling to and from the Hospital for the 3 to 4 weeks of daily External beam radiotherapy treatment, all any costs incurred, fuel, car parking, time, etc.

    Hi Lavendergirl - Don't be annoyed with yourself, believe me, it was one of the hardest things I have had to do, at a time when my brain would not take anything in, not knowing anything about anything, trying to find someone that had gone through this combined treatment. Trying to weight up all the pro's and con's, etc.  Originally, I thought I had found a local Consultant that said he could give me the combined treatment I wanted. I was waiting for a surgery date, something didn't feel right, I made enquires, dug deeper, I found the radiotherapy treatment to be used was different to what I had asked for, I was nearly misled into having a 'similar' treatment - not the treatment I had asked for.  It took courage to say, I would not be going forward with this treatment, it wasn't what I'd asked for. I thank God that I picked up on this.  This 'hiccup' made me pull my sleeves up and go all out to have the TARGIT treatment at London. 

    Hi Snowys Mum - I don't know about empowering, mind blowing and frightening come to mind - I'm not a confident person, I tend to 'put on a front' - I worried so much about 'stepping out the box' for the conventional treatment, so many 'what if's'.  When I spoke with the Professors Secretary she help put my mind at rest, even to the point of saying, 'come down and meet everyone and see what you think, if you don't like us, and you might not, all you have lost is your time coming down here and your train fare'.  I was given mobile phone numbers to both of the Secretary and the Professor.  The Professor even phoned me the night before we were travelling down to see them, it was just turned 9.00pm saying he had my biopsy results - and wanted to put my mind at rest. I have peace of mind knowing I can contact them at anytime.

    I'm sorry I have waffled on, I couldn't find a post relating to this kind of treatment, I felt it only right to share what I have gone through. I know I would have appreciated reading about this treatment, I'm just sorry I have waffled on.  Hey, you never know, it may be available free of charge to all suitable women soon xxxxx

    I'm hoping this makes sense - only my mind says one thing and my fingers type whatever they like x
  • Wow - yippy - it looks like approval is getting closer.

    For all ladies coming along this path in the near future - it looks like this treatment is one step closer or even here...

    https://www.nice.org.uk/guidance/TA501

    just going to have a read. 

    I hope this is the case, I was blessed to be able to have this treatment - it will save suitable ladies in the near future over 3 to 4 weeks of external Radiotherapy.

    I'm hoping this makes sense - only my mind says one thing and my fingers type whatever they like x
  • I am on this trial. Haven’t read the report but I had radiotherapy at the time of my lumpectomy. Apparently had about 45 minutes. My surgeon had asked if I would be willing to take part which , of course, was a no brainer!! 

    Don’t know what else it will entail, all I have been told was the radiotherapy at time of surgery, taking letrozol and monitored for 10 years rather than 5.

    I will have paperwork to complete over the years. However I will still have radiotherapy when chemo is finished but have been advised only 3 weeks instead of 4/5.i just think this amount of radiotherapy at surgery is such a boost it can only be good. My surgeon advised this has been trialled in Germany with good results, why are we always so far behind???

    Good luck everyone whatever your doing and however your feeling, the only way is UP!!

    Xxx

    Love Edwina xx

    Back here again for hubby diagnosed with oesophagus cancer - Sept. 2021   Face palm tone2

    You’re allowed to scream  - You’re allowed to cry  - But do not give up

    MAMMOGRAMS save lives, I'm the proof!!! 

    7 rounds of chemo, finished 30th May 2018. 15 zaps of radiotherapy, finished 26th July 2018.

    I Survived .......... Sadly my hubby did not.Pensive

     

     

  • Hello , it is so lovely to speak to someone else that has had this.  I had to go private for this treatment and agreed to be part of the trial too - I believe it is to follow up the treatment and to take into account of everything we go through.

    I so hope this gets to the NHS - the trouble is, its a catch 22 - more people need to write to NICE pushing for this to be passed, however most don't know anything about it until they get diagnosed - then doctors 'don't mention' this option - so it gets hidden. Hence, NICE don't receive letters most BC patients pushing for this treatment to get approval - because they have had to get on with the treatment thats available now.

    I paid to have this treatment (using savings and borrowing)  - this treatment should be available on the NHS to everyone suitable.

    I am not good at campaigning or letter writing, I will wherever possible let anyone and everyone know about this type of treatment.  

    This saves ladies that are suitable for this type of treatment - single lump/lumpectomy (I'm not sure if its suitable for men), this saves ladies having 3/4 weeks external radiotherapy, saves them from having sore skin, time travelling daily to appointments, if anything comes back they can have radiotherapy treatment 'again' (with the external type you can't have it on the same breast again) - well I would like them to know about it and I would like them to be able to have this treatment as standard on the NHS.  Its is so near - yet so far xxx

    I'm hoping this makes sense - only my mind says one thing and my fingers type whatever they like x
  • FormerMember
    FormerMember in reply to WhatHappened

    Hi

    Just want to say what a lovely post.  I didn’t know about this treatment, but my husband did and asked at my diagnosis appointment. We were promptly told “we don’t do that here”.


    It’s great that you have both agreed to the trials, so helpful and beneficial to other women, so wanted to give a big thank you to you both.

  • FormerMember
    FormerMember in reply to FormerMember

    Dear All,

    I came across IORT treatment by research only.  It has now been approved by NICE but NHSE have not released the money for funding therefore it is still not available under the NHS.  Possible funding by May or even Summer 2018.  I have enquired and will have to go private to receive this treatment or wait until funding is released, which is not an option.  

    So many decision and I thought the hardest part was being diagnosed.