Whole-Breast
Radiation For Breast Cancer Gets Thumbs Up
Further
Understanding Of Partial-Breast Therapy Sought In NCI
Study
It is called
partial-breast irradiation, and proponents see it as a promising alternative
treatment for breast cancer patients who have just had a lumpectomy.
Thousands of women have already sought out the therapy,
which requires just one week or less of radiation after breast cancer
is diagnosed, instead of the six or seven weeks required for whole-breast
irradiation.
But its long-term benefits remain unproven, some experts
caution.
That is why the National Cancer Institute
(NCI) has launched a major study of this experimental
therapy this fall, to offer women sound guidance based on years of observation.
Dr. Gary Freedman, a radiation oncologist at Fox Chase
Cancer Center in Philadelphia, is urging a cautious approach.
Dr. Freedman says some studies looking at the benefits
of partial-breast irradiation five years after treatment have produced
acceptable results. But, he adds, "Five-year results aren't long enough
to say, 'This is a standard alternative.'"
Interest in partial-breast irradiation heightened after
the US Food and Drug Administration (FDA) approved
a new radiation device in 2002. Bearing radioactive seeds, it is implanted
after a lumpectomy into the site from which the tumor has been removed
and then delivers radiation to that area only, not the entire breast.
The therapy is proving popular with women who find the
short timetable far more convenient.
This year, more than 200,000 people in the US will
be diagnosed with breast cancer, according to American
Cancer Society (ACS), and more than 40,000 are expected to
die from the disease.
Whole-Breast
Radiation Versus Partial-Breast
Partial-breast irradiation is based on the fact
that most recurrences of cancer appear at the site of the original tumor,
not other parts of the same breast.
Whole-breast irradiation works by treating the entire
breast with radiation to prevent undetected cancer cells that might
have escaped from the original tumor from spreading to other parts of
the same breast.
Dr. Freedman presented a study at the annual meeting
of the American Society of Therapeutic Radiology and Oncology
on the benefits of whole-breast irradiation.
He reported that the follow-up data on whole-breast
irradiation is much longer than that for the newer technique. His research
also showed that 15 years after a lumpectomy, the cancer recurrence
rates were nearly the same at both the original tumor site as well as
other parts of the breast.
Dr. Freedman evaluated 2,700 women who had whole-breast
irradiation to assess the cancer recurrence rate in that breast.
After five years, the recurrence rate at the original
tumor site was 3 percent, while it was 1 percent in other parts of the
same breast. After 10 years, it was 6 percent at the original site and
2 percent in other parts of the same breast. But after 15 years, the
recurrence rates were 9 percent at the initial cancer site and 7 percent
in other parts of the same breast.
This suggests that whole-breast irradiation must remain
the standard - at least for now, Dr. Freedman.
More
Studies Needed, Experts Say
Dr. Herman Kattlove, a medical oncologist and spokesman
for the ACS, also counsels patience until more is known
about partial-breast irradiation's long-term effectiveness.
"We're concerned that [partial-breast irradiation] hasn't
been proven," he says. "It's too early to tell" if it will bear out
as a treatment as effective as whole-breast irradiation. "I would recommend
caution," he says.
"We're awaiting results of [the ongoing] clinical trials,"
he adds. "We need to have that data."
Dr. Freedman concurs. "Standard treatment is certainly
[irradiating] the whole breast," he says. If women want to try the partial-breast
irradiation treatment, he adds, they should do it in an approved clinical
trial.
Always consult your physician for more information.
Partial-Breast
Radiation Methods
The American Cancer Society provides
the following information on partial breast radiation methods:
Low-dose Breast Implant - Women receive
a low-dose implant during an eight-day hospital stay.
High-dose Needle Brachytherapy - From
outside the breast, physicians place 10 needles with slender tubes in
and near the tumor area. They insert tiny "seeds" for a few minutes
twice a day for four days.
Catheter Balloon Device - a physician
inserts a catheter into the tumor cavity during a lumpectomy or through
a small incision a few days later. A balloon device goes in, is filled
with saline solution, and radioactive "seeds" are guided in for five
minutes twice a day for about a week.
External beam radiation - Some centers
can treat part of the breast with external radiation equipment. They
focus four or five beams on the tumor site, rather than the whole breast.
This is also known as quadrant irradiation.
Always consult your physician for more information.
Promising
New Radiation Therapies
Many new radiation techniques are being used and studied
to find more effective treatments for cancer. Some of the more promising
therapies are described below:
radiation and chemotherapy in combination
Depending upon the particular type of cancer, physicians may choose
to combine radiation with chemotherapy. Radiation may help to shrink
tumors before surgery, for example, and chemotherapy may be used afterward
to kill cancer cells not removed by surgery. Research is being conducted
in this area.
intraoperative radiation
Intraoperative radiation is the use of radiation during surgery
to treat cancerous tumors or other forms of cancer. This treatment decreases
the area of affected tissue because a larger dose of radiation can be
used. For some people, intraoperative radiation improves the outcome
of their treatment. Intraoperative radiation may be used in addition
to external radiation.
stereotactic radiation
This is an important new development in the treatment of brain cancer.
Stereotactic radiation is the use of a single high dose of radiation
sent into cancerous tissue with very narrow beams of radiation. This
is a precise technique that is painless. An example of this technique
is called the “gamma knife."
particle radiation therapy
Particle radiation therapy is the use of higher-energy radiation particles
in cancer therapy. It may work well to treat tumors that recur after
being removed, or tumors that cannot be treated through surgery.
three-dimensional (3D) conformal radiation therapy
Protocols and techniques for three-dimensional conformal radiation therapy
are being developed. This type of therapy may help the cancer care team
visualize and treat tumors in a more precise way than ever before.
thermoradiotherapy (hyperthermia)
Scientific experiments have shown that the use of high temperatures
localized at the treatment site improves the success of radiation therapy.
Further research is currently being conducted to learn more about this
treatment option.
radioimmunotherapy
This type of radiation therapy involves using antibodies "tagged" with
a special substance. These tagged antibodies recognize tumor cells and
bind with them. By doing so, the antibodies bring cancer medication
in contact with the tumor. Radioimmunotherapy may be helpful in treating
cancer that has spread to other parts of the body.
Always consult your physician for more information.
Online
Resources
American
Cancer Society
American
Society for Therapeutic Radiology and Oncology
American
Society for Clinical Oncology
Centers
for Disease Control and Prevention (CDC)
National
Institutes of Health (NIH)
National
Women's Health Information Center |
January 2004
In
This Issue:
Whole-Breast
Radiation For Breast Cancer Gets Thumbs Up
Whole-Breast
Radiation Versus Partial-Breast
More
Studies Needed, Experts Say
Partial-Breast
Radiation Methods
Promising
New Radiation Therapies
Radiation
Therapy Facts
Risks
and Side Effects of Radiation Therapy
Online
Resources
Other
Resources:
St.
John's Mercy Cancer Services
Find
a St. John's Mercy Physician
Breast
Health Information
Women's
Health Information
St.
John's Mercy Classes and Programs
Radiation
Therapy Facts
Radiation therapy is given through different
methods, depending on the type of cancer, the location of the cancer,
and the patient's health.
Sometimes, radiation therapy is used
in combination with other treatments. The following are some of the
different types of radiation therapy with brief explanations of their
goals:
external radiation (external
beam therapy)
With external radiation (external beam therapy), radiation
is administered by a large machine that points the energy waves directly
at the tumor. The radiation therapist controls the machine. Since
radiation is used to kill cancer cells, special shields may be made
to protect the tissue surrounding the treatment area. Radiation treatments
are painless and usually last a few minutes.
internal radiation (brachytherapy,
implant radiation)
With internal radiation (brachytherapy, implant radiation),
a high dose of radiation is given inside the body as close to the
cancer as possible. The radiation treatment may be swallowed, injected,
or implanted directly into the tumor.
Some of the radioactive implants are
called “seeds” or “capsules”. Internal radiation
involves administering a higher dose of radiation in a shorter time
span when compared with external radiation.
Some internal radiation treatments stay
in the body temporarily; other internal treatments stay in the body
permanently, although the radioactive substance loses its radiation
within a short period of time.
Risks
and Side Effects of Radiation Therapy
Radiation therapy is a painless cancer
treatment, though it can irritate skin.
The biggest risk of radiation therapy
involves potential damage to normal cells, in addition to the cancerous
cells. This damage to the normal cells can cause some side effects,
which will be monitored and treated by your cancer treatment team.
As each person's individual medical profile
and diagnosis is different, so is his/her reaction to treatment. Side
effects may be severe, mild, or absent.
Be sure to discuss with your cancer care
team any/all possible side effects of treatment before the treatment
begins. Consider the following potential side effects of radiation
therapy:
skin irritation
Sometimes, radiation irritates the skin, causing it to become red,
sore, and/or dry. For some people, skin irritation can become a troubling
side effect. If you experience irritated skin during radiation treatment,
consult your physician regarding how to treat the problem.
fatigue
Fatigue is a common side effect for all cancer patients. After weeks
of radiation therapy, most people experience fatigue. Fatigue often
resolves after treatment is completed.
Scientists have not determined the exact
cause of fatigue. It may result from many factors, such as stress,
pain, or a loss of sleep. Experts suggest that cancer patients with
fatigue save their energy by limiting their activities.
Ask friends and family to help you with
certain tasks, such as grocery shopping. Try to rest as much as possible.
Also, including some light exercises, such as walking, into your daily
routine may help you build energy.
hair loss (alopecia)
Hair loss can occur around the area being treated with radiation.
For example, if you have radiation to your head you may lose hair
on your scalp. However, if you are receiving radiation to your lung,
you will not lose hair on your head. Hair usually grows back after
treatment is finished.
If you experience hair loss on your scalp
following treatment for a head or neck cancer, you may consider wearing
a wig. Other people choose to wear a hat or scarf. Or you may decide
that none of these options are right for you. If you choose to wear
something on your head, make sure it is comfortable and does not irritate
your skin.
blood changes
White blood cells and platelets can be affected by radiation therapy.
Oncologists monitor blood counts during treatment to detect any problems.
In some cases, the red blood cells can also be affected if radiation
therapy is directed to large areas of bone marrow.
It depends on your blood count, but your
physician may choose to adjust your treatment if your white blood
cell and platelet counts decrease. Since these blood cells fight infections
and prevent bleeding, treatment may even stop for a while until the
blood counts increase.
oral health
Radiation treatment to the head and neck can cause dry mouth, difficulty
in swallowing, cavities, gum destruction, sores in the mouth, redness
and irritation, altered taste and smell sensations, and other side
effects. It is important to take good care of your mouth, teeth, and
throat during radiation therapy. Seeing a dentist before you start
your radiation treatments can help prevent problems.
If you experience oral health problems
during radiation treatment to the head or neck, talk to your physician
and dentist about what you can do.
diarrhea, nausea, and vomiting
Radiation therapy to the abdomen or stomach may cause these side effects.
Some patients experience nausea and an upset stomach a few hours after
radiation treatment to the abdomen or stomach. Some patients find
it helpful to eat a light meal a few hours prior to their treatment,
while others prefer not to eat before their radiation treatment.
It is very important to maintain proper
nutrition before, during, and after your radiation treatments. The
main goal is prevent weight loss.
difficulty in eating
Eating may be difficult during treatment. Radiation treatment can
interfere with your body's ability to absorb and digest food. It is
also normal to lose weight during radiation therapy, but eating a
balanced diet is important.
Talk to your physician or a registered
dietitian regarding what you should eat if you experience problems
such as a loss of appetite. Patients who eat well usually cope better
with treatment, both mentally and physically.
Always consult your physician for more
information.
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