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
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.