Why Radiate the Whole Breast When You Don’t Have To?

Breast cancer patients who require post-surgical radiation typically go through what is called “whole breast radiation.” In this procedure, the radiation oncologist directs high-energy x-rays at the entire breast to kill any cancer cells that may remain after surgery.

Though this type of radiation is often effective at preventing recurrence, it can come with uncomfortable side effects, including breast tenderness, radiation burns, swelling, fatigue, and blistering and peeling skin. It may also shrink the size of the breast, potentially damage nerves, and in rare cases, expose part of the heart or lungs to damaging radiation.

Because of these effects, scientists have been looking into ways to target the radiation so it focuses strictly on the area immediately around where the tumor was. Limiting the coverage area could help reduce side effects. It could also allow for a higher dose per treatment, which could help women complete this part of their therapy in a matter of days rather than weeks.

The answer seems to be what’s called “partial-breast irradiation.” Scientists have explored a number of ways to perform this type of treatment, as the important thing is to make sure to still get all the cancer cells so the patient doesn’t suffer recurrence.

According to a recent study, women treated with a certain type of partial radiation seemed to do just as well as those who received whole breast radiation.

Women Should Ask Their Doctors About Partial-Breast Irradiation

For the study, researchers gathered data from just over 1,100 women with a median age of 59 years who went through breast-conserving surgery and “accelerated partial breast irradiation” using “interstitial multicatheter brachytherapy.”

This type of radiation treats breast tissue from the inside. It’s called “accelerated” because treatment is usually completed in five days, rather than over the course of several weeks. The radiation oncologist inserts a soft, slender tube called a “catheter” into the cavity left behind after removal of the tumor. (Sometimes more than one catheter is used.)

The docor then inserts a radioactive “seed” about the size of a grain of rice into the catheter. It travels to a designated position and does its work, and then is removed. The skin and surface tissues are exposed to no radiation at all.

Researchers followed the treated women for about seven years. They found that on the whole, the women who went through this type of accelerated radiation experienced no differences in outcomes compared to women who received whole-breast radiation for up to six weeks.

According to lead author Dr. Mitchell Kamrava, the results indicated that “more women should discuss this treatment option with their doctors.”

Other Studies Show Similar Results

This isn’t the only study completed on partial-breast irradiation. Scientists have been pursuing it for a while because it spares healthy tissue from the effects of radiation, reduces side effects, and can significantly reduce treatment time.

A 2013 study, for instance, found that women who suffered a recurrence of breast cancer were effectively treated with a lumpectomy and partial-breast irradiation with catheters, with overall survival equivalent to those who went through a mastectomy.

Another 2015 study found similar results. Researchers looked at data from just over 3,000 women who received breast conserving surgery and either whole-breast irradiation or accelerated partial-breast irradiation. They found that after 10 years, the women showed no difference in recurrence or survival. In other words, both methods seemed to work equally well.

Could You be a Candidate?

In addition to brachytherapy, which uses catheters to deliver the radiation, there are two other methods of partial-breast irradiation:

• Balloon based: Oncologists use a special tube with a balloon on one end that is placed in the breast where the cancer was. This balloon holds the radioactive seed near the effected area and is removed after the last treatment.
• 3-D external beam: This type of radiation is similar to standard radiation, as it’s delivered outside the body, but it uses a special MRI or CAT scan to map out small treatment fields that are more focused, helping to avoid unnecessary tissue damage.

So far, the internal radiation methods using the catheters or balloons have more positive studies behind them.

If you are scheduled for a lumpectomy and have been told you need radiation therapy after surgery, check with your doctor about your options. If you are a candidate for partial radiation, you may experience faster treatment and reduced side effects. Before moving forward, make sure that your doctors have adequate experience in the field of partial-breast irradiation.

 

Sources

Kamrava M, et al., “Outcomes of Breast Cancer Patients Treated with Accelerated Partial Breast Irradiation Via Multicatheter Interstitial Brachytherapy: The Pooled Registry of Multicatheter Interstitial Sites (PROMIS) Experience,” Ann Surg Oncol., April 28, 2015, http://www.ncbi.nlm.nih.gov/pubmed/25916980.

“Accelerated Partial Breast Irradiation (APBI),” MD Anderson Center, http://www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/cancer-treatment/radiation/partial-breast-irradiation/index.html.

Hannoun-Levi JM, et al., “Accelerated partial breast irradiation with interstitial brachytherapy as second conservative treatment for ipsilateral breast tumor recurrence: multicentric study of the GEC-ESTRO Breast Cancer Working Group,” Radiother Oncol., August 2013; 108(2):226-31, http://www.ncbi.nlm.nih.gov/pubmed/23647758.

Jessica Wobb, et al., “Ten-year outcomes of accelerated partial breast irradiation compared with whole breast irradiation: A matched-pair analysis,” Am J Clin Oncol., March 27, 2015, http://www.ncbi.nlm.nih.gov/pubmed/25822231.

“Study Suggests Partial-Breast Radiation Just as Good as Whole-Breast Radiation After Lumpectomy,” Breastcancer.org, September 28, 2013, http://www.breastcancer.org/research-news/20130928-4.

 

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