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'Targeted' therapy vs. traditional

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An alternative to traditional radiation could allow some breast cancer patients to be treated in less time, according to a small study presented Monday in Denver at the annual meeting of the American Society for Therapeutic Radiology and Oncology.

Women who opt for lumpectomy, in which doctors remove only the cancerous tumor rather than the entire breast, also typically have radiation therapy to kill any leftover malignant cells.

Treatments are given five days a week for six to seven weeks -- a schedule that is difficult for many women, especially those who live in rural areas or who can't take off time from work, says Martin Keisch, a radiation oncologist at Mount Sinai Comprehensive Cancer Center in Miami Beach and lead author of the study.

Some women even choose mastectomy over lumpectomy because they cannot get to so many treatments, Keisch says.

A new procedure, called balloon brachytherapy, might help some of those women keep their breasts, Keisch says. The system delivers radioactive "seeds" through a catheter to the cavity once occupied by the tumor. Because the treatment is so targeted, it exposes less healthy tissue -- only about a quarter of the breast -- than traditional radiation, which exposes the whole breast. It allows doctors to use bigger doses of radiation for a shorter time -- just five days, he says.

The technology, called the MammoSite Radiation Therapy System, was approved by the Food and Drug Administration in 2002. None of the 43 women in the study has relapsed, says Keisch, who has followed patients for an average of four years. He says brachytherapy also causes relatively little cosmetic damage.

Bennie Benjamin, 70, of Miami had a balloon brachytherapy about two years. Benjamin says the procedure wasn't painful, and she was even able to drive herself home from treatments. Although the procedures caused some discoloration and peeling, she said, those effects were temporary.

If balloon brachytherapy proves as safe and effective as traditional radiation, Keisch estimates about 100,000 American women a year might be able to benefit.

But it's too soon to know whether the technology prevents relapses as well as traditional radiation, says Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. "I would be cautious if I were advising a woman," Lichtenfeld says. "We don't have the type of evidence that we really need."

To answer those questions, researchers from the National Surgical Adjuvant Breast and Bowel Project and the Radiation Therapy Oncology Group have begun a large clinical trial to compare the effect of radiating part of the breast vs. the whole breast. Doctors will study 3,000 women at 150 sites in the USA and Canada.

The new procedure causes some of the same side effects as traditional radiation, such as inflammation, redness and pain, Keisch says. Brachytherapy also poses a small risk of infection, because doctors have to make an 8-millimeter incision to insert catheters containing the radioactive seeds.

And the MammoSite still exposes the skin, ribs and lungs to radiation, says Carol Marquezan associate professor at Oregon Health & Science University.

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© Copyright 2004 USA TODAY, a division of Gannett Co. Inc.

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