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Mehra Golshan, MD
Al-Tuwaijri Distinguished Chair in Surgical Oncology
Medical Director International Oncology Programs
Director Breast Surgical Oncology Fellowship
Brigham and Women's Hospital
Dana Farber Cancer Institute
Associate Professor of Surgery
Harvard Medical School
- Seeking to improve success rates in breast cancer surgery.
- Clinical trials are planned to explore advanced imaging techniques to improve breast surgery outcomes.
- These studies are improving standard procedures to reduce the need for multiple surgeries and to improve overall breast cancer outcomes.
Breast conserving surgery is standard treatment for early-stage breast cancer and allows for less invasive breast reconstruction after surgery. It is not uncommon, however, for a patient to have to return to the operating room after initial surgery because the first surgery did not remove all the tumor. Dr. Golshan is testing an interoperative imaging technology to improve surgery outcomes.
Full Research Summary
The goal of Dr. Golshan’s research is to reduce the need for multiple breast cancer surgeries with the use of interoperative MRI (performed during surgery) and biomarkers to guide a more complete cancer removal during lumpectomy.
For patients with early-stage breast cancer, breast-conserving surgery (lumpectomy) along with whole breast radiation is a standard approach in treatment. The foremost goal of breast conserving surgery is to remove the cancerous tissue and leave the patient with a cosmetically acceptable result.
Despite improvements in surgical techniques and imaging, challenges remain in achieving tumor free margins during breast cancer surgery, often requiring patients who undergo lumpectomy to face additional surgery to achieve complete tumor removal.
The negative impact of additional surgeries leads to delays in chemotherapy and radiation, increased mastectomy rates, higher rates of infection, higher health care costs, and increased psychological distress in patients undergoing breast cancer surgery.
In a phase I trial supported by BCRF, Dr. Golshan’s group demonstrated that intraoperative MRI (iMRA) improved complete tumor removal during surgery, potentially reducing the need for a return to the operating room later. The study also showed that the tumor position within the breast varied significantly when comparing the standard MRI position of the breast (women lying face down) with the operative position (women lying face up).
Two phase II trials are ongoing to further efforts to identify tumor markers that separate normal tissue from cancerous tissue, improve surgical results for women with early stage breast cancer, and determine the best technique of breast MRI in advanced breast cancers.
Mehra Golshan, MD, a breast surgical oncologist, is the Medical Director for International Oncology Programs at the Dana-Farber/Brigham and Women’s Cancer Center, Dr. Abdul Mohsen and Sultana Al-Tuwaijri Distinguished Chair in Surgical Oncology, and Associate Professor of Surgery at Harvard Medical School.
His primary clinical research interest focuses on minimizing the extent of surgery required for women with breast cancer through the use of neoadjuvant therapies and novel intra-operative techniques. The focus of the preoperative therapy trials is to target treatment for breast cancer and develop genotypic profiles that will in the future lead to individualized tailored therapies for patients with breast cancer.
The cornerstone of his research in improving patient surgical outcomes relies upon intra-operative tumor assessment with mass spectrometry (Dr. Nathalie Agar lab) and breast MRI. In the United States, up to 40 percent of women who undergo lumpectomy will need a second operation to achieve clear margins. He and his colleagues are studying the use of these intra-operative diagnostic biomarkers and tools in the Advanced Multimodality Image Guided Operative Suite (AMIGO) at the Brigham and Women’s Hospital to determine if they can identify and remove residual tumor while the patient is under anesthesia, with the aim to improve patient outcomes and reduce re-excision rates.
BCRF Investigator Since
The Hale Family Award