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F E AT U R E•Faster Treatmentand Recoveryfor CancerIntraoperative radiotherapy following breast lumpectomyspeeds recovery, reduces cost By Mary Ellen ZenkaIntraoperative radiotherapy allowed CathyFriedman to keep running.Dennis R. Holmes, M.D.,with the Intra Beamdevice, which can delivera targeted dose ofradiation during surgery.22KECK MEDICINE | Winter 2011 IssueHelping people face personal difficulties is the goal ofthe trauma and crisis intervention organization whereCathy Friedman is associate director. Last January,Friedman faced her own crisis – she was diagnosedwith breast cancer.“It came as a total surprise,” says Friedman. “I hadabsolutely no risk factors. No one in my family everhad breast cancer. I am a vegetarian who exercisesregularly, and I breast-fed my children.”She knew she needed surgery and was informedabout the standard six weeks of post-surgical radiation,but she did not want to endure the long treatmentand recovery process, and miss running in the LosAngeles Marathon. A runner for 30 years, she hasraced in the marathon for the past five years.Friedman was referred to Dennis R. Holmes,M.D., director of intraoperative radiotherapy andbreast surgeon at USC Norris Comprehensive CancerCenter and Hospital. Holmes explained to Friedmanthat because her type of cancer allowed for breastconservation, she would have the option of enteringthe TARGIT Trial – an international clinical trial ofintraoperative radiotherapy.“Rather than the typical multi-week course of radiation,the cancer site receives radiotherapy immediatelyafter tumor removal using a device called theIntra Beam, manufactured by Carl Zeiss Meditec,”explains Holmes, who is assistant professor of clinicalsurgery at the Keck School of Medicine of USC.“The Intra Beam is directed into the breast and canprecisely dispense radiation to the targeted area. Theprocedure takes as little as 17 minutes as compared tothe usual 30-35 days over six weeks.”Standard radiation covers the full breast and cancause injury to surrounding organs and the skin of thebreast. The advantage of intraoperative radiation isthat a lower dose can be used because the radiationis administered to the interior of the breast and doesnot pass through the skin. Intraoperative radiationalso permits the temporary insertion of internal radiationbarriers to protect the underlying heart and lungfrom the effects of radiation.An added benefit is the reduced cost of treatment –one-third to one-half the cost of standard radiotherapy.“More than 2,200 patients around the world havereceived this new form of radiotherapy with excellentresults. Cancer recurrence rates using intraoperativeradiotherapy are statistically equivalent to standard radiationtechniques,” Holmes says. He is upbeat aboutwhat this means for improving treatment for women.“USC Norris is now a leading institution, and theonly one in Southern California, for both defining thefuture of this technology and expanding the trial forpatients who might not have qualified for the TAR-GIT trial,” Holmes says.For Friedman, the choice was simple. The intraoperativetherapy option was quick with none of the sideeffects commonly experienced with standard radiation.“I took one week off to recover from my procedure,and I returned to my marathon training activitiesthe next week. I am so pleased to have found Dr.Holmes,” Friedman says. “His caring demeanor andrecommendation for my inclusion in the TARGITTrial calmed my breast cancer crisis – something Itruly value.” •For further information or an appointment, contactHolmes’ referral coordinator at 323-865-3628.Photo by Philip Channing (left); Photo by Greg Mancuso (top)
F A C U LT Y P R O F I L E •Helping Patients Walk,Run and Play By Martin BooePhoto by Philip ChanningD a n i e l A . O a k e s remembers the exact momentwhen he set his sights on becoming an orthopaedicsurgeon. As a resident doing a rotation in orthopaedics,he assisted in knee replacements for an elderlywoman whose mobility was severely compromisedby rheumatoid arthritis. A day later, he saw her makingher way down the hallway − on a walker, yes, butmoving more nimbly than she had in years.“There was the biggest smile on her face,” Oakesrecalls. “Her quality of life had been restored, andI’ll never forget how thrilled she and her family were,how grateful. I was hooked.”Oakes became director of the USC Joint ReplacementProgram and associate professor of clinical orthopaedicsat the Keck School of Medicine of USC inMarch 2010, and he feels like a kid in a candy shop.“The beauty of practicing in a surgery care centerlike this is having the institutional support in anesthesiologyand physical therapy. USC has a long history ofexcellence in joint replacement surgery, and my goal isto continue that tradition and establish us as a center ofexcellence for joint replacement,” he says. “We wantto become a destination for our surrounding community,a place people know they can go for more seriousproblems. We’re doing a high volume of revision surgeries– in other words, we didn’t create the problemsbut we fix them – and that backup [from other departments]enables us to take on more difficult cases.”Oakes is no stranger to Southern California, norto USC. He was a member of the Keck School facultyfrom 2004 to 2006 before serving as chief of theUCLA Joint Replacement Service and assistant professorof orthopaedic surgery. At UCLA, he developeda thriving joint replacement division and wasa leader in resident education. He returned to theTrojan family in 2010.Oakes was born in Boston but grew up in the BayArea. A Harvard Medical School graduate, he completedhis residency training and a research fellowshipin orthopaedic surgery at UCLA Medical Center.Oakes completed an adult reconstruction fellowshipat the Mayo Clinic in Rochester, Minn.His wife, Vanessa Walker-Oakes, is an art historianwho teaches Advanced Placement Art History and is thedirector of college counseling at the Flintridge PreparatorySchool in La Cañada. The couple has four young sons.Oakes saw dramatic advances in hip and knee replacementprocedures during his residency, and thepace of change has only accelerated since then. The useof less invasive surgical approaches in conjunction withregional anesthetic protocols, rather than general anesthesia,has helped to better control post-operative pain,improve early mobility and shorten hospital stays.The patient demographic requiring total joint replacementsurgery is changing, as patients are younger,more active and have high functional expectationsafter surgery. Treatment of the younger patient is anongoing area of research.Infections after a hip or knee replacement are oneof the most feared complications (national infectionrate is 0.5 percent). The USC Joint Replacement Programhas tremendous experience in caring for thesepatients with good success.“The lesson learned from these cases is that more attentionneeds to be given to prevention. While we knowhow to treat infection cases, we are becoming even betterat preventing them from occurring,” Oakes says.“There’s a lot of satisfaction knowing your patientsare going to get better with the right operation, andthat’s what I love about joint replacement surgery,”he says. “Part of the challenge is that people’s expectationsare so much higher. Performing activitiesof daily living and walking without pain used to beconsidered a success. Our patients today are muchmore active than their predecessors. Now they wantto ride 100-mile bike rides and play in competitivetennis tournaments. We’re always striving to improveto keep up with increasing inpatient expectations.”As for Oakes’ extracurricular activities: well, hehas those four young boys, ages 1 to 11. Spare time?“What’s that?” he jokes. •For a joint replacement consultation, contact 323-442-5860or uscjointreplacement@health.usc.edu.Daniel Oakes, M.D.,brings a wealth ofexperience in replacingdeteriorated joints, suchas hips, with state-ofthe-artprostheses.keck.usc.edu KECK MEDICINE 23
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