Promising Early Results
Study Weaknesses
New Clinical Trials Opening
A Safety Net
How it Works

A different radiation treatment approach for women whose tumors were removed by lumpectomy may prove to be a patient-friendly development for the treatment of localized breast cancer. But experts say women should carefully review the facts behind short course, partial-breast radiation before choosing this treatment.

It treats just the breast tumor area instead of the whole breast after a lumpectomy for early stage breast cancer. It can take as little as one week, depending on the method used.

Early results suggest the new treatment works as well as the standard one to prevent cancer from returning in the same breast in selected patients – but it will take several more years to prove without a doubt that the two treatments are equally effective. More details are described below.

"This is an exciting and impressive new treatment, but it has not yet been proved equal to whole breast radiation," said Carolyn Sartor, MD, a North Carolina radiation oncologist who specializes in breast cancer. "This is not yet considered ready for prime time for all women," she added.

The recent study looked at two types of partial-breast radiation that were given inside the affected breast, a method known as brachytherapy. Radiation sources called "seeds" are placed in the area where the tumor has been removed. The study did not include the use of a catheter balloon device that came on the market about a year ago.

Whole breast radiation, the current standard, uses a radiation source outside the body to treat the entire breast, and takes five to six weeks of treatment, five days a week

Last month, Michigan researchers published five-year results from their study of 199 carefully selected women who had the two internal methods of partial breast radiation after lumpectomy. All had early breast cancer, most had tumors of 20 mm. or smaller, and most had no signs of cancer in the lymph nodes. Also, most patients had generous margins of normal tissues surrounding the excised cancer.

Researchers led by Frank Vicini, MD at William Beaumont Hospital in Royal Oaks tracked the women for at least five years, and compared them with patients who had whole breast radiation. Each woman who had the experimental treatment was matched by age, tumor size, and several other factors with a woman who had the standard treatment.

The partial breast treatment prevented cancer from returning in the same breast just as effectively as the standard treatment over five years. The evidence points out that the local control rate and survival are the same," explained Peter Chen, MD a researcher and co-author for "Limited Field Radiation Therapy in the Management of Early-Stage Breast Cancer," published in the Journal of the National Cancer Institute, (Vol. 95, No. 16: 1205-1210). .

Also, only 1 of 79 women followed for five or more years had an unsatisfactory cosmetic result from the brachytherapy.

Other cancer specialists warn that the Michigan study only provides a short-term look at partial breast radiation. A small risk of recurrence continues for ten years or longer. "We need longer follow-up. A five year follow up is reasonable, but premature," explained Sartor.

Another problem is that 70% of the participants had additional treatments to prevent or delay a cancer recurrence, including taking tamoxifen for a few years. So more time will be needed to isolate the effects of the radiation treatment alone.

Enrolling in a clinical trial is a good option if women want to try partial-breast radiation now. All members of the medical team will be well trained and must follow strict guidelines. Internal breast radiation does require a whole team of specialists, with major input from the pathologists who examine tissue samples to be sure the woman is eligible for the treatment. "It's all based on the pathology. I cannot emphasize that too strongly," said Dr. Chen. Women who participate will be helping to answer important questions. "We really need their help. The women who participate in studies now are going to make a difference for patients in the future," said Sartor. "We're only as good as the people who want to participate in clinical trials," she added. Dr. Sartor offers a final bit of advice: "This is not standard therapy. If you can't get into a clinical trial, stick with something that's proven."

Find a clinical trial of partial breast radiation National Cancer Institute: Call 1-800-4-CANCER for information about enrolling in a new, multiple-location study of partial breast radiation. NCI is recruiting at least 6,000 breast cancer patients. Women with up to three positive lymph nodes will be included, according to Dr. Chen. Local Trials: Several medical centers plan to run single institution trials. Ask your doctor and check with local medical centers. Clinical Trials Search: ACS has an online matching service for clinical trials.

Six weeks of daily whole breast radiation after a lumpectomy is a hardship for some women, which pushes them to choose a mastectomy instead. Partial-breast radiation could be a solution. "It significantly shortens the length of radiation exposure and for women who have to travel long distances that's great," said Christie Russell, MD of the USC/Norris Comprehensive Cancer Center in Los Angeles, and a member of the ACS Breast Cancer Council.

Russell sees great promise for the future of internal breast radiation, including the little-studied catheter balloon device, but possible drawbacks too.

"A potential problem is if localized radiation makes it harder to detect another cancer. A lot of scarring could change the breast so it isn't soft enough to feel a new lump. It could take longer to detect another cancer."

And the long-term cosmetic effects are unclear. Early testing of the internal treatment called high-dose needle brachytherapy changed the look and feel of the breast for some women. "It affected the skin, it was inferior cosmetically," said Russell. .

But given all the limitations, Russell says, "If a woman does not want to place herself through six weeks of radiation therapy, and she has wide margins, this could be a reasonable choice."

There is a type of safety net for women who try the new treatment. If breast cancer returns in the same breast, it can be successfully treated with a mastectomy, so a recurrence doesn't shorten a woman's life. Russell said for that reason, "I don't see any threat from this treatment to long term survival."

Michigan researcher Chen envisions a future where radiation treatments are much more precise and easier for patients. "…I think in the end, five or ten years from now, as we get better at categorizing patients' disease characteristics, we'll be able to tailor treatments more and more to the disease site, rather than the whole organ."

Partial Breast Radiation Methods