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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 and reduce the need for subsequent surgeries with advanced imaging techniques and biomarkers.
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.
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.
With support from BCRF, Dr. Golshan and his colleagues use a combination of intraoperative mass spectrometry (performed during surgery) and magnetic resonance imaging (MRI) to more accurately identify the margins between cancerous and normal breast tissue to improve breast-conserving surgery.
Dr. Golshan's team has completed a phase I trial demonstrating that intraoperative MRI (iMRI) is a feasible method of identifying residual tumor during breast surgery and that iMRI has significant potential for helping patients avoid additional operations for early-stage breast cancer. The results using iMRI were significantly enhanced with the patient in a supine (lying down, facing upward) position rather than prone (facing downward), which is the standard imaging position.
The team has now initiated two phase II trials to continue investigating advanced imaging techniques for margin evaluation during breast surgery. In one trial, they are comparing mass spectrometry, a technique that has shown potential in distinguishing cancerous tissue from normal tissue, and iMRI. In the second trial, they are comparing breast MRI when patients are lying face up compared to face down.
These trials will help further efforts to identify tumor markers that separate normal tissue from cancerous tissue, improve surgical results for women with early stage breast cancer, determine the best technique of breast MRI in advanced breast cancers, and reduce the need for multiple surgeries.
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