Women undergoing breast cancer treatment get just as much benefit from a one-time hit of radiation directed into the tumor site as they would from an extended, daily regimen of radiation over the entire breast, according to research released today.
The international study, which involved more than 2,200 patients worldwide and 93 women at UCSF, showed that four years after treatment, the chance of having a recurrence of cancer was about the same for both radiation methods. The study looked at women with early breast cancer who were treated with surgery to remove a tumor.
The benefit of a one-time, direct-hit radiation treatment is primarily convenience - women would be treated while under sedation, immediately after having a tumor removed, and they probably would avoid a lengthy regimen of daily radiation treatment.
"This is the next step in opening up a broader range of options for women," said Dr. Michael Alvarado, a surgical oncologist at UCSF and one of the study authors. "We've been doing radical radiation for 20 years, and it's time to realize not all women fit the same paradigm."
The major drawback of the study, said doctors and breast cancer research advocates, is that it was able to follow women for only four years after their cancer was diagnosed. It's not unusual for cancers to reoccur after eight or more years, and it's possible that further study will show small but significant differences in recurrence rates between the two radiation treatment options, oncologists said.
Follow-up needed
"This is a major, landmark study," said Dr. Robert Carlson, an oncologist with the Stanford breast Cancer Center. "But it probably needs follow-up of eight to 10 years."
This study, results of which were published today in the Lancet, started in 2000 and included women from nine countries. Participants were randomly assigned to get either the new one-time, targeted radiation therapy or the standard weeks-long therapy. About 15 % of the women who got the targeted therapy ended up also getting the extended therapy because of hospital protocols.
With the targeted therapy, a rod was inserted into the area of the breast where a tumor was removed, which is the most likely spot for a recurrence of cancer. Radiation was applied through the tip of the rod for 20 to 35 minutes. With extended therapy, radiation was applied to the entire breast for about 15 to 20 minutes. Extended therapy lasted five days a week for three to seven weeks.
There were six recurrences of cancer in the targeted therapy group and five recurrences in the extended therapy group, which is not a statistically significant difference. Both groups also reported about the same number of complications from radiation, including infections; breakdown of the skin or delayed healing in the area that was treated; and pain in the breast or nearby areas. Such complications are rare.
Breast cancer research advocates said they are encouraged by the results, but they noted that the targeted treatment is years away from becoming standard practice and is not available to most women.
"The first thing I would point out is caution: This is not ready for prime time yet," said Barbara Brenner, executive director of Breast Cancer Action, a San Francisco advocacy group. "I'd like to see 10-year data on this therapy, and I'm sure the scientists would too.
"But I think this is hopeful. A lot of people will jump at this treatment if it's available. Many women would choose to get it over with, if they were confident that they would not be sacrificing anything in terms of outcome."
Happy to participate
Elysa Yanowitz, for one, was thrilled to be included in the study at UCSF. She was diagnosed with breast cancer two months ago, at the same time that her mother was becoming increasingly ill with ALS. Yanowitz said she was distraught at the idea of visiting her mother in the hospital every day on top of getting her own radiation.
She was randomly selected to get the one-time radiation therapy. Yanowitz had the tumor removed and got the radiation last Friday, and now she feels relieved to have the treatment behind her.
"I didn't physically or psychologically have the strength to deal with daily radiation," said Yanowitz, 63. "I broke down and cried when they told me I might be able to get it done in one day.
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