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While it has been conclusively shown that radiation following lumpectomies reduces the risk for breast cancer recurrence, the traditional six-week, whole-breast radiation therapy can be difficult to follow for patients who need to return to work or live far from a cancer center.
Now there's an alternative on the horizon: targeted radiation that sends medicine directly to the site of the tumor and takes only five days to complete.
The high-tech methods aren't new. Select groups of women with a good prognosis for recovery have had access to the shortened, intensive therapy and have had success, doctors report. Now it's 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.
Vicini is the chief investigator for a National Cancer Institute study that began last March, which 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 toward," Vicini says.
Seventy percent to 75 percent of the 200,000 American women who are diagnosed with breast cancer annually are candidates for lumpectomies, largely due to early detection, according to the U.S.
Department of Health and Human Services. 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.
For the new study, women who meet certain criteria -- including having a tumor that's no more than 3 centimeters in diameter, and having 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 U.S. Food and Drug Administration 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, Vicini says.
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, manufactured by Proxima Therapeutics in Alpharetta, Ga.
"For some patients who don't need the whole breast radiated, their treatment can be completed much more quickly," Moulds says.
Dr. Shawna Willey is a breast surgeon and director of the Betty Lou Ourisman Breast Health Center at Georgetown University Hospital, which is participating in the National Cancer Institute study. She says the investigation of the new radiation techniques is reminiscent of the introduction of lumpectomies in the 1980s.
"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 won't 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," Willey says.
"There are still patients who have mastectomies."
(The HealthDay Web site is at http://www.HealthDay.com.)
c.2006 HealthDay News
