Breast cancer patients may benefit from new accelerated treatment

Women with early-stage breast cancer may benefit from a new, accelerated approach to radiation therapy making their course of treatment shorter, according to a new study released today in the International Journal for Radiation Oncology-Biology-Physics, the official journal of ASTRO.

According to the American Cancer Society, more than 213,000 women will learn they have breast cancer this year. Breast cancer can be detected through a routine mammogram; often before the woman herself can detect a lump in her own breast. Women who are found to have an abnormal mammogram will have a biopsy to test for the presence of cancer cells. If cancer cells are detected, most women will undergo a lumpectomy and some additional treatment that may include hormone therapy, radiation therapy or chemotherapy or a combination of the three.

With traditional radiation therapy, patients can expect daily radiation treatments for a period of 6 to 6 1/2 weeks. Doctors in this study, however, wanted to examine the use of an emerging new technology, proton beam therapy, in an accelerated regimen to determine how well this treatment would be tolerated. This approach to breast cancer treatment would essentially shorten the course of treatment to less than one week while also delivering radiation to only a portion of the breast, thereby sparing the surrounding healthy tissue and organs.

This study was conducted at the Francis H. Burr Proton Therapy Center at Massachusetts General Hospital in Boston with 20 female participants. The women in the study were being treated for Stage I breast cancer and received proton beam partial breast irradiation twice a day for four days. There were no given limitations on the type of additional treatment options available for participants. Consequently, patients were allowed to be treated with hormone therapy and chemotherapy at the discretion of their treating oncologists. The majority of the women in this study received hormonal therapy and a few of the patients received chemotherapy.

Patients were then evaluated at different stages of follow-up, at 3 to 4 weeks, 6 to 8 weeks, 6 months and every 6 months after that. Patients were required to undergo annual mammograms after the treatment period and the patients were asked to grade their cosmetic outcome, or their breast’s aesthetic appearance. Early side effects from radiation therapy can include skin irritation at the site of the radiation beam, skin discoloration or thickening of the skin; accelerating the amount of radiation during treatment could increase the instance of side effects.

Patients judged their own breasts under the criteria given to them and the doctors who supervised this study in turn graded the condition of the participants’ breasts as well. Patients were also asked to describe their overall satisfaction with the accelerated proton beam partial breast irradiation.

The results showed that all 20 women were found without any evidence of recurrent disease. The initial response to the cosmetic appearance of the patients’ breasts, however, was not ideal. Both patients and doctors reported fair to poor cosmesis, but the appearance of the patients’ breasts substantially improved in most patients by the 6 month follow-up. According to the study, 95 percent of patients reported total satisfaction with the proton treatments at their latest follow-up visit.

“This study represents a crucial first step in identifying potential roles for proton beam therapy in the care of patients with breast cancer,” said Alphonse G. Taghian, M.D., Ph.D., senior author of the study. Kevin R. Kozak, M.D., lead author of the study, added, “We hope our team and others will build on these results to ensure breast cancer patients will maximally benefit from the recent, and dramatic, technological advances in our field.” Drs. Taghian and Kozak are radiation oncologists at Massachusetts General Hospital in Boston.

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