Women with early-stage breast cancer could
benefit from a shorter, more intense radiation therapy, a team of Canadian
researchers found in an analysis which was presented Monday at a conference in Boston. The treatment
takes only one to three weeks compared to five to seven weeks for standard
therapy.
Canadian researchers tested the
shorter-course technique in 1,200 women who were randomly assigned to either
accelerated radiation treatment or standard therapy between 1993 and 1996. Half
of the women had 25 treatments in 35 days (five treatments a week for a period
of five weeks) and the other half received the alternative treatment which
included 16 treatments in 22 days. The alternative technique, called accelerated
hypofractionated whole breast irradiation, requires three weeks of daily,
15-minute visits and costs two-thirds as much.
The participants were followed for a period
of 12 years. At the end of the study, researchers found no significant differences
between the groups. Researchers found a recurrence rate of 6.2 percent in patients
treated with accelerated radiation therapy compared to a recurrence rate of 6.7
percent in patients receiving standard therapy. Both groups had a “good or excellent
cosmetic outcome,” meaning the breast wasn’t highly affected by the radiation.
“We were surprised that the risk of local
recurrence and side effects for women treated with accelerated whole breast
irradiation was so low even at 12 years,” said Dr. Timothy Whelan of McMaster University
in Hamilton, Ontario. Dr. Whelan estimated that 60 to 70
percent of women with early-stage breast cancers in Canada were already receiving this
type of therapy.
“There has been renewed interest in
hypofractionated whole breast irradiation due to the potential radiation
advantages, patient convenience, quality of life and lower costs,” Dr. Tim
Whelan of McMaster University in Toronto,
who led the study, said in a statement.
“However, I would encourage women whose
breast cancer is caught early to talk to their oncologist to see if they are a
good candidate for this shorter therapy,” Dr. Whelan said.
In a second study presented at the meeting of
the American Society for Therapeutic Radiology and Oncology, Dr. Peter Beitsch
and colleagues at Medical City Dallas Hospital in Texas
followed patients who have had partial breast radiation. The treatment, called accelerated
partial breast irradiation (APBI), focuses radiation at the site of the removed
tumor using a special single balloon catheter that delivers the radiation
through tiny radioactive seeds. The procedure worked as well as standard
radiation among 400 women followed for four years. The recurrence rate was
similar to that seen in standard whole-breast radiation.
Dr. Beitsch said the procedure may even increase
the rate of breast conservation. He said that some women choose masectomy because
they live too far from a radiation center and cannot afford the time of so many
weeks of living or travelling to the center.
“These are preliminary results, but they
suggest that outcomes for carefully selected patients are as good as those with
full breast radiation,” Beitsch said.
The FDA approved the accelerated partial
breast irradiation (APBI) in 2002. But the procedure is not widely used for the
treatment of breast cancer. The practice is more common in Canada and Europe.
Breast cancer is the leading cause of
cancer death among women worldwide, according to the American Cancer Society. About
180,000 women a year develop breast cancer in the United States and most need
radiation treatment.