19294 Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure)

Name of the Procedure:

Preparation of Tumor Cavity with Placement of a Radiation Therapy Applicator for Intraoperative Radiation Therapy (IORT) Concurrent with Partial Mastectomy

Summary

This procedure involves preparing the area where a breast tumor was removed (tumor cavity) and placing a radiation device to deliver targeted radiation therapy during the same surgery as the partial mastectomy.

Purpose

This procedure addresses breast cancer by combining tumor removal and immediate localized radiation treatment to kill any remaining cancer cells. The goal is to reduce the risk of cancer recurrence and minimize the need for additional radiation therapy sessions.

Indications

• Diagnosed with early-stage breast cancer.
• Candidate for breast-conserving surgery (partial mastectomy).
• Anticipated benefit from immediate localized radiation therapy.

Preparation

• Fasting for a specified period before surgery (usually from midnight the night before).
• Preoperative imaging studies like mammography or ultrasound.
• Consultation regarding current medications and any needed adjustments.
• Blood tests and a physical examination.

Procedure Description

1. The patient is placed under general anesthesia.
2. A partial mastectomy is performed to remove the tumor and a margin of surrounding tissue.
3. The tumor cavity is prepared by ensuring it is clear of any residual tumor cells.
4. A specialized radiation therapy applicator is placed into the tumor cavity.
5. Intraoperative radiation therapy (IORT) is administered, directly targeting the tumor bed.
6. The applicator is removed, and the surgical site is closed.

Duration

The entire procedure typically takes 2-3 hours, including the time for both the partial mastectomy and the IORT.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon (breast surgeon)
• Radiation oncologist
• Anesthesiologist
• Surgical nurses
• Radiation therapy technologists

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Adverse reaction to anesthesia
• Radiation-related skin changes or burns
• Swelling or bruising
• Risk of lymphedema
• Rarely, damage to surrounding tissues or organs

Benefits

• Enhanced killing of residual cancer cells in the tumor bed.
• Immediate radiation treatment, reducing the need for multiple sessions.
• Lower recurrence rate of breast cancer.
• Shorter overall treatment time.

Recovery

• Monitoring in the recovery room immediately following surgery.
• Pain management with prescribed medications.
• Instructions on caring for the surgical site.
• Follow-up appointments for wound check and discussion of further treatments if necessary.
• Most patients can resume normal activities within a few days to weeks.

Alternatives

• Standard partial mastectomy followed by external beam radiation therapy:
  • Requires multiple visits over several weeks.
  • Less convenience but wide availability.
• Total mastectomy:
  • More extensive surgery.
  • Reduced risk of local recurrence but more significant physical and psychological impact.

Patient Experience

During the procedure:

• The patient will be under general anesthesia and will not feel any pain. After the procedure:
• The patient may experience mild to moderate pain, manageable with medication.
• There may be some swelling, bruising, and fatigue.
• Physical activity may be limited for a short period, depending on recovery speed.
• Emotional support may be needed due to the psychological impact of cancer treatment and surgery.