Advancements in radiation therapy in treating breast cancer.

Major advancements in radiation therapy have occurred over the past decade. Radiation therapy uses high dose x-rays to deliver external beam radiation therapy, or radioactive isotopes to treat with internal radiation. Breast cancer cells have long been known to be sensitive to radiation treatments. Radiation therapy is given to the breast after lumpectomy to allow a woman to keep her natural breast. Radiation therapy can also be recommended to some women after mastectomy to prevent the cancer from returning and prolong survival.

Radiation therapy techniques have dramatically improved over time. There is now stereotactic radiosurgery (SRS) as well as stereotactic body radiation therapy (SBRT) to treat tumors that have spread to the brain or body. These techniques use multiple beams targeting tumors to deliver a high dose to the tumor with excellent local control. At Huntington Cancer Center, patients can be treated on our Elekta treatment machine, which uses 4D imaging to allow us to monitor and treat a tumor in the lung while the patients’ lungs are moving. This helps our patients with cancer that has spread to have a much better quality of life, avoid surgery, and control small tumors.

New “hypofractionated” (shorter courses of) radiation therapy has shown to be effective with the same cosmetic results in post lumpectomy patients. Large trials in the UK showed that three weeks of treatment was equal to five weeks of whole breast radiotherapy. Side effects were similar and cosmetic results were identical. Of course, a shorter course of treatment is more cost effective and certainly much more convenient for patients. Hypofractionated radiation therapy is now the standard of care for women over 50 with early stage breast cancer, and recent studies have shown that it is actually better tolerated.

Selected early stage breast cancer patients may also be candidates for partial breast irradiation (radiation). This can be delivered with an implant approach with internal radiation therapy using a radioactive isotope, or with external beam techniques. Huntington Cancer Center is the center of excellence for the SAVI (strut adjusted volumetric implant) partial accelerated breast irradiation therapy. Patients are treated twice a day over a 5-day course of therapy. However, with the new shorter courses of radiation, partial breast external beam radiation is extremely convenient and is usually the treatment of choice.

Multiple recent clinical trials have shown that radiation therapy to the axilla, or armpit area, can be given instead of surgery to remove the lymph nodes. Radiation to those nodes offers equivalent control with less complications such as nerve pain or chronic swelling of the arm (lymphedema). Even in patients who have cancer that has spread to the nodes, radiation can control the disease and help avoid surgical removal of them, which improves quality of life. Women with large tumors and nodes positive for cancer spread, post-lumpectomy or post-mastectomy, are often offered radiation to the chest and regional nodes to avoid a local recurrence and improve survival.

Overall survival for breast cancer patients has been improving over the past decade with extremely effective treatments reducing the risk of recurrence. Ongoing trials, in which Huntington Cancer Center participates, will continue to define the future of radiation therapy for breast cancer.

Radiation therapy is no longer a “one-size fits all” treatment. Radiation treatments are now customized for each particular patient.

  • Hypofractionated radiation techniques with shorter courses of treatment have dramatically improved the quality of life for patients undergoing radiation therapy.
  • Shorter courses are better tolerated with the same long-term control and certainly greater convenience.
  • For early stage breast cancer patients, shorter courses of radiation therapy have been shown to be effective and more convenient with equal cosmetic results.
  • Stereotactic radiation techniques can treat tumors in the brain or body eliminating the need for surgery and drastically improving the quality of life for patients living with cancer that has spread.
  • Radiation therapy can be used to treat the axilla (armpit) instead of removing the lymph nodes in that area.
  • Major improvements in radiation therapy for breast cancer patients are decreasing the risk of chronic lymphedema (buildup of fluid in the body’s tissues) in patients’ arms, as well as decreasing pain after surgery and preventing nerve issues like numbness or weakness.
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