Study Backs Short, Intense Radiation for Breast Cancer 

When it comes to radiation therapy for breast cancer, slow and steady does not always win the race.

New Treatment Course Following a Lumpectomy

New research finds a shorter, more intense course of radiation after a lumpectomy seems to be equally effective as the standard course, which is longer but with less radiation each time.

Although experts agree that radiation therapy after surgery to remove a malignant tumor reduces the risk of a recurrence, there is no consensus on how long that treatment should last.

Currently, most treatments last for four to six weeks. In the new study, appearing in the Journal of the National Cancer Institute, researchers gave patients modestly higher bursts of radiation for only three weeks.

Shorter Treatment Offers Benefits to Women

"This shorter treatment is going to be a lot more convenient for women," says Dr. Timothy Whelan, study author and an assistant professor of medicine at McMaster University in Hamilton, Ontario. "The other thing from the healthcare perspective is that you can reduce the cost by half almost, so the ramifications are really huge."

This is not a new treatment for breast cancer, experts say.

"We've probably known for some time that we can probably speed up radiation a little bit, but I don't think that's where the action is," says Dr. Alan J. Stolier, medical director of the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans. Cutting-edge research these days involves localized radiation, such as brachytherapy, which targets the tumor rather than the whole breast.

On the other hand, shortening conventional radiation therapy has the advantage of being something many women can take advantage of now.

"In Canada, we consider this a win-win situation for women and for the healthcare system," Whelan says. "This is standard treatment for women now. I think it's a big breakthrough. You could have this tomorrow. Tomorrow, you could reduce your treatments by half."

Details About the Study

In this study, Whelan and his colleagues randomized 1,234 women who had undergone lumpectomies for their breast cancer into two different treatment arms. One received the more intensive radiation (30 percent more) over 22 days, and the other received the conventional, less intensive radiation over 35 days. None of the cancers had spread to the lymph node.

After six years of follow-up, there appeared to be no difference in recurrence of the breast cancer or in cosmetic outcome. Local recurrence-free survival was 97.2 percent in the "short" group and 96.8 percent in the "long" group.

The authors counsel, however, that the shorter therapy is not recommended for women with very large breasts.

New Treatment to Become the Standard?

Should this new course of radiation therapy become the new standard? The authors of an editorial in the same issue of the journal give a qualified "yes." Women who have small tumors that have been successfully removed might benefit.

At the very least, the findings expand the range of options.

"I think we're going to end up with a menu," Stolier says. "It's great to have more than one choice, and we can select certain choices that take into account the characteristics of patients and their tumor, but also the [professional] skills that happen to be available."

Always consult your physician for more information.

In Other Breast Health News

Mastectomies: More Is Not Better

When it comes to mastectomies, new research shows that more is not better.

A 25-year update of the first randomized clinical trial to ever look at this issue finds that a radical mastectomy is not more effective than a simple mastectomy, in which lymph nodes and muscles are left in place. In this latest follow-up, both procedures produced essentially the same survival rates.

The findings appear in a recent issue of the New England Journal of Medicine.

The "B-04" trial, as it is called, launched the trend towards less surgery to treat breast cancer.

"This was one of the most important trials ever in breast cancer," says Dr. Alan J. Stolier, medical director of the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans. "It told us that what we thought might be true intuitively was not true, that more was not better. The cure was the same whether we did a more simple procedure versus a more radical procedure. This trial was one that was given credit for doing away with most radical breast surgery."

"This opened the door for what we are now doing," says Dr. Bernard Fisher, the study's author and scientific director of the National Surgical Adjuvant Breast and Bowel Project (NSABP), which conducted the trial. "This was the turning point in the story of the surgical management of breast cancer, plus it led to the understanding that you weren't going to cure more people by bigger operations, and that you needed systemic therapy in order to do that. And that opened the door for chemotherapy."

In 1971, when the study first started enrolling women, radical mastectomy—in which the entire breast, muscles of the chest wall and nearby lymph nodes are all removed—was the norm.

However, not all physicians agreed and they pushed for less invasive procedures. To resolve the controversy, the NSABP started the B-04 trial.

The study involved 1,765 women who were randomly assigned to one of three groups. The first group received a radical mastectomy. The second got a simple mastectomy, plus radiation. The third received a simple mastectomy without radiation.

"There was no difference in the outcome by any of the three methods," Fisher says.

Twenty-five years later, the survival rate for all three groups was 14 percent if their lymph nodes tested positive for cancer at the time of surgery. The survival rate for all three groups was 23 percent, on average, if the lymph nodes tested negative for cancer at the time of surgery.

At the time the trial started, biopsies and mastectomies were done at the same time, while the woman was under general anesthesia.

Stolier, then a resident, operated on some of the women in the trial and remembers waiting in the operating room with the whole surgical team for the biopsy results to come back. If the diagnosis was cancer, Stolier was handed a white envelope that contained which of the three procedures he was to perform on the woman, still asleep on the operating table.

Part of the significance of the trial is its sheer length.

"I don't know of anything else that long," Fisher says. "It provides the first real solid natural-history information to what happens to these women."

A substantial proportion of women had recurrences of breast cancer after the watershed five-year mark, indicating the need for long-term follow-up, even when the patient has a good prognosis.

Because none of the women in the study received chemotherapy, the trial also serves as a good baseline for what is accomplished with the addition of chemotherapy, Fisher says.

"I don't know of any other studies that really have that information," he adds.

Always consult your physician for more information.