Breast cancer: radiotherapy in 1 minute instead of 6 weeks, a first!

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Replace 6 weeks of radiotherapy with … 40 seconds of irradiation, it is now possible for some patients with breast cancer. Performed during the operation to remove the tumor, this short irradiation is made possible by a new device, the Papillon +, designed by Professor Jean-Pierre Gérard, Radiotherapist at the Center Antoine Lacassagne (Nice). In the course of testing, it could soon treat 10% of patients, specifically the older ones with small tumors.

1 minute of irradiation during the operation instead of 6 weeks of radiotherapy

The Papillon +, named in honor of a former professor of Pr Gérard, is not the first machine to allow irradiation of tumors during the operation. The Intrabeam, German design, has indeed arrived on the market ten years ago, and can do it in 30 to 40 minutes of irradiation. The principle is simple for both machines: once the tumor is removed, the surgeon and oncologist radiotherapist position on the site a spherical applicator to place an X-ray tube. The irradiation is then delivered, the patient still being under anesthesia. General. Designed from this technology in partnership with the British start-up Ariane Cpy, Butterfly + can deliver the same dose of X-rays in just 1 minute – 40 seconds during the two operations already carried out – thanks to a patented cooling system. "This saves the surgeons time because they do not have to leave the operating room for half an hour", explains Professor Gerard, interviewed by Science and Future. The director of the hospital also sees operating rooms released more quickly, and thus a considerable time saving.

In 1 as in 30 minutes, to carry out the irradiation during the operation has a psychological advantage for the patient: "it dramatizes the disease"The first patient who had benefited from Papillon + was operated on October 26, 2018 in the morning, was woken at noon and returned home at 7 pm A performance, when we know that the standard treatment of cancer breast includes several days of hospitalization after the operation, followed by 6 weeks of radiotherapy.A heavy treatment, especially for the 50% of patients who are over 70 years old.

Treatment reserved for patients over 70, with small tumors

It is particularly because of the fragility of the oldest patients that Pr Gérard believes that the use of Butterfly + should be reserved for them. But another reason makes younger patients less suitable candidates: breast density. The latter, which is a function of the amount of tissue relative to fat, makes the tumors more difficult to characterize in young subjects, whose mammary density is higher. However, it is important that patients receiving Papillon + have tumors less than 2 cm, classified T1 on a scale up to T4. "There is a greater risk of having tumor cells on the periphery of large tumors compared to small ones", says Professor Gerard, cells that could escape the very targeted X-ray beam of the Butterfly + or Intrabeam, and cause a relapse.We must not sacrifice the risk of relapse of patients to the simplicity of treatment for caregivers", adds Pr Gérard, whose goal with his Papillon + is to get less than 4% relapses and 0% of toxicity for the 20% of patients over 70 years with a relatively small tumor.

An ongoing clinical trial on 46 patients

Butterfly + is also used outside the surgical process, in cancer of the rectum or skin. According to Pr Gérard, it can also be tested in cancer of the uterus. In the meantime, the device is used in Lyon, Mâcon and Nice. The current clinical trial will include 46 breast cancer patients to demonstrate its efficacy, which should be completed in the year 2019. At the same time, the Agence du Médicament (ANSM) is in the process of officially approve the use of Intrabeam for common use in French centers. "This should be done in 2019", explains Professor Gerard.And of course, clinicians will claim to be able to do it in 1 minute rather than 30", he adds, expecting to see the Butterfly + approved in the wake of his predecessor.