Intensive Radiation Therapy Success Story Continues
Targeted radiation that sends radiation directly to the site of a breast cancer tumor and takes only five days to complete has shown success in early studies, say experts.
Leading physicians say it has been conclusively shown that radiation following lumpectomies reduces the risk for breast cancer recurrence.
Seventy percent to 75 percent of the 200,000 women in the US who are diagnosed with breast cancer annually are candidates for lumpectomies, largely due to early detection, according to the US Department of Health and Human Services (HHS).
Radiation treatments are recommended as a follow-up to the breast-conserving procedure, in which a limited amount of tissue is removed, to reduce the risk of recurrence.
But traditional six-week, whole-breast radiation therapy following lumpectomy can be difficult to follow for patients who need to return to work or live far from a cancer center, they say.
The shortened, high-tech therapy is not new - select groups of women with a good prognosis for recovery have had access to this intensive therapy and have had success.
Now, it is time to test the benefits of the treatment on a wider population and compare the results to the traditional six-week therapy, physicians say.
"These patients did extraordinarily well, and we felt that it would be appropriate, since the results were so good, to open up the indications to allow more patients to have the therapy," says Dr. Frank Vicini, chief of oncology at William Beaumont Hospital in Royal Oak, Mich.
Dr. Vicini is the chief investigator for a National Cancer Institute (NCI) study that began last March that will eventually enroll 3,000 early stage cancer patients to compare the results of six-week, whole-breast radiation with three alternative intensive five-day therapies.
"We've proved that radiation works, and now we're trying to show whether or not we can shorten the amount of time it will take to deliver the radiation, and to reduce the amount of tissue that we target the radiation towards," says Dr. Vicini.
For the new study, women who meet certain criteria - including having a tumor that is no more than 3 centimeters (just over one inch) in diameter, and no more than three lymph nodes that are cancerous - will be randomly assigned to either the traditional six-week whole breast radiation therapy or one of three, short-term therapies.
These therapies include a balloon brachytherapy system called MammoSite®, approved by the US Food and Drug Administration (FDA) in 2002, that involves placement of a balloon in the breast at the tumor site.
A single tube delivers radiation into the balloon, which is done every day for five days. At the end of the week, the balloon is removed, notes Dr. Vicini.
The second therapy is interstitial brachytherapy, an older delivery system that involves as many as 20 catheters inserted into the breast to carry radiation to the tumor site.
The third therapy will involve radiation focused only on the tumor site, the least physically invasive of the three short-term options.
Dr. Jefferson E.C. Moulds, an assistant professor of radiation medicine at Georgetown University's Lombardi Comprehensive Cancer Center, says he has treated a small group of women with the MammoSite balloon.
"For some patients who don't need the whole breast radiated, their treatment can be completed much more quickly," explains Dr. Moulds.
Dr. Shawna Willey, a breast surgeon at Georgetown University Hospital, says the investigation of the new radiation techniques is reminiscent of the introduction of lumpectomies in the 1980s. Dr. Willey is participating in the NCI study.
"This is a parallel to what happened with mastectomy versus breast conservation surgery in the 1980s," she says, with the challenge of making sure the new therapies are as good, if not better, than what already exists.
But even if the new radiotherapies prove effective for many patients, they will not be for everyone, she says.
"I see a lot of patients who read about something and say, 'This is for me,' but it's important to note that not every person is going to be a candidate for these procedures," says Dr. Willey. "There are still patients who have mastectomies."
Always consult your physician for more information.
|
There are two types of breast conservation (tissue-sparing) surgery. These include a lumpectomy and a partial (segmental) mastectomy.
A lumpectomy is the removal of the breast cancer and a portion of normal tissue around the breast cancer lump.
The surgeon may also remove some of the lymph nodes under the arm to determine if the cancer has spread.
The bean-shaped lymph nodes under the arm (also called the axillary lymph glands) drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions.
Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body.
Radiation therapy is often administered following a lumpectomy to destroy cancer cells that may not have been removed during the lumpectomy procedure.
A partial (segmental) mastectomy involves the removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer.
The surgeon may also remove the lining over the chest muscles below the tumor and some of the lymph nodes under the arm.
Radiation therapy may also be administered, following a partial mastectomy, to destroy cancer cells that may not have been removed during the partial mastectomy procedure.
If a woman does not choose a breast-conserving surgery, she may choose a mastectomy (removal of the breast).
The physician may recommend a mastectomy under the following circumstances (among others):
-
if the cancer has spread to other parts of the breast tissue or has spread to the lymph nodes under the arm
-
if the breast is very small and a lumpectomy would require removing additional breast tissue, resulting in a very deformed breast
There are three types of mastectomy. Your physician can explain the benefits and risks of each type:
During a total (or simple) mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and most of the overlying skin) and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands.
During a modified radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), some of the lymph nodes under the arm (also called the axillary lymph glands), and the lining over the chest muscles.
In some cases, part of the chest wall muscles is also removed.
During a radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), the lymph nodes under the arm, also called the axillary lymph glands, and the chest muscles.
For many years, this was the standard operation. However, today, a radical mastectomy is rarely performed and is generally only recommended when the breast cancer has spread to the chest muscles.
Always consult your physician for more information.
|
