A relatively new radiation-therapy technique being used at Rockwood Clinic PS's Cancer Treatment Center, in Spokane Valley, can help minimize the onset of some of the harsh side effects women suffer when undergoing radiation treatment, says Rockwood radiation oncologist Dr. Robert Pfeffer.

Pfeffer says other advantages of this newer technique, called prone radiation therapy, include faster treatment sessions and the application of a more accurate, or in some cases smaller, dosage of radiation.

Side effects for radiation therapy, also called radiotherapy, experienced by breast cancer patients range in severity and can include inflammation, scarring, and the risk of radiation exposure to nearby internal organs such as the heart, he says.

For breast cancer patients who are at a higher risk of experiencing such side effects, Rockwood is using the prone radiation therapy technique. That means the patient lies face down during treatment, rather than face up, or in the supine position, which is considered a more traditional position for such therapy, Pfeffer says.

Rockwood began offering prone radiation therapy early this year, he says. The treatments are performed through the radiation therapy and PET/CT services clinic in the Valley center, at 12410 E. Sinto. Pfeffer joined that clinic about a year ago and says he first used the prone-position approach about three years ago while practicing radiation oncology at facilities in Great Falls and Helena, Mont.

"Eliminating any direct cardiac irradiation during breast cancer radiotherapy was so important to me that it was one of the first things I started doing after arriving here," Pfeffer says.

A patient receiving radiation therapy through this newer approach lies on her stomach on a special device placed on top of a table that's connected to the machine that applies the radiation dose. The wedge-shaped device raises the patient's torso above the flat table, and at the top half of the wedge is an opening that's positioned at the breast level and allows the patient's breast to hang down and away from her chest.

The machine then directs the treatment beam at the tumor. Because the woman's breast is pulled away from her chest, other parts of the body are positioned farther away from the potentially harmful beams, Pfeffer says.

"If a patient is prone, the breast is pulled away from the heart and the lung, and we can tell them that they have no area of their heart in the treatment beam," he says. "Many women are scared of radiation damage to their lungs or heart."

He adds that since gravity also pulls the woman's breast downward, the tissue becomes more thinly stretched than if she were lying on her back and the tissue was spread out around her chest. Having that breast tissue thinly stretched means that the noncancerous areas of tissue also receive less radiation, he says, because the machine can focus the beam more accurately only on the affected area. That can also result in less inflammation of the breast tissue for some patients, Pfeffer says.

Because the machine can more precisely focus the treatment beam on the tumor with the patient lying on her stomach, in some cases treatment times also are shorter, he adds.

Pfeffer says that for a patient with larger breasts, prone radiation therapy can be significantly more beneficial than supine therapy for those same reasons.

Another side effect of radiation therapy can be shrinking of the breast tissue within a few years following treatment, he says.

"The results that I have seen in my practice using this position with women with larger breasts are a decrease in delayed scarring and shrinkage," Pfeffer says.

While Pfeffer says using prone radiation therapy to treat breast cancer has many positive aspects, he wouldn't recommend it to all breast cancer patients.

"It sounds like the ideal treatment, and in many ways it is, but it's not for everyone even though for certain patients it is a big improvement," he says.

Patients he wouldn't recommend receive prone radiotherapy include women who've had a mastectomy and have had a recurrence of cancer, or breast cancer patients who have numerous neighboring lymph nodes that also have become affected.

Later this year, the same Cancer Treatment Center plans to deploy another new upgrade to its radiotherapy equipment, Pfeffer says.

That new technology—called RapidArc and manufactured by Varian Medical Systems Inc., of Palo Alto, Calif.—can be used on patients with breast, cervical, and some types of uterine cancer, as well as some other cancers, Pfeffer says.

That upgrade is estimated to cost about $450,000, he says.

The benefit of the procedure offered through the RapidArc device is a significantly decreased treatment time and a reduced chance of the radiation beams reaching other organs, he says.

The device works by rotating 360 degrees around the patient without stopping as it applies the radiation to a cancerous tumor, Pfeffer says. That continuous movement reduces the amount of time it takes to administer a treatment to two minutes or less, down from between 15 and 20 minutes.

The device's technology also allows it to apply the radiation beam to the tumor from more angles than Rockwood's existing equipment, he says.

Because the RapidArc collapses the radiation beam into a small cloud around the tumor, Pfeffer says the chance that the radiation will reach other areas of the body is decreased.

"So the advantage for the patient is twofold; they are spending less time in treatment and will see a decrease in side effects," Pfeffer says.

In addition to treating Rockwood's breast cancer patients, Pfeffer also works with the patients who have other types of cancer, including prostate and lung cancer.

Before coming to Rockwood, Pfeffer worked at Cancer Care Northwest, of Spokane, for a short time. Prior to that, he practiced radiation oncology in Montana for 18 years.

Pfeffer says of all types of cancers he treats, breast cancer is the most common because he works closely with Rockwood's Breast Health Center and its three surgeons, also based at the Spokane Valley Cancer Treatment Center.