Targeted breast radiation treatment – in half the time, same recurrence risk odds
Wendy Lybarger plants flowers at her home in Dayton, Ohio. After having a lumpectomy for early-stage breast cancer, Wendy was able to complete radiation in just five days using a method that focused treatment to the small area where the tumor was.
Thanks to scientific and technological advances, breast cancer is being detected earlier in many women when it is very treatable. In fact, many women are able keep their breasts with a lumpectomy and breast radiation therapy with the same cure rate as breast removal (mastectomy). There is no doubt, however, that cancer treatment can quickly flip life upside down in both time and cost, especially for people navigating cancer care while managing career or family obligations. In particular, radiation therapy for breast conserving treatment often involves daily visits to a hospital for up to several weeks.
But science shows that for many women with low-risk,
early-stage breast cancer, a shorter course of highly targeted breast radiation around the surgical site is a safe and effective option that results in similar long-term survival rates and recurrence risk compared with whole breast irradiation.
In this scenario, patients can complete radiation over five consecutive days versus the traditional four to six weeks of treatment involved with whole breast radiation.
For United Methodist Church pastor Wendy Lybarger of Dayton, Ohio, this was an ideal choice that allowed her to balance the importance of pursuing the best treatment to eradicate her cancer while minimizing disruption to the rest of her life.
“I felt good about the science-backed decision for my care. I asked questions and did the research to land on a less invasive, more
convenient treatment plan that didn’t compromise my long-term risk for recurrence,” says Wendy, who completed treatment in time to host all of her children and grandchildren for Christmas in 2019.
She wants others to know it is important to be your own
advocate: “Don’t be afraid to ask the questions so that—when the decisions are made—you
have confidence in what is happening and that you made the best decision for you. This allowed me to thrive and, with the support of my faith community, personally allowed me to go into the treatment
with a calm and peace.”
Guiding care with science
Data from a phase III national clinical trial involving researchers from the OSUCCC – James compared whole breast irradiation with partial breast irradiation in a large group of women with stage 0, I or II breast cancer. More than 4,200 patients were enrolled in the trial as part of an NRG Oncology cooperative group clinical trial.
Study results showed that, while partial breast irradiation
does not produce equivalent cancer control for all breast cancer patients with stage 0,
I and II disease, it should still be considered as an alternative for women with DCIS (ductal carcinoma in situ) and earlystage breast cancers deemed “low risk” based on other tumor characteristics.
When researchers looked at the entire study population 10 years after treatment, they found that women who received partial
breast irradiation experienced a 4.6% recurrence rate. Those who underwent whole breast irradiation experienced a 3.9% rate of recurrence, a less than 1% difference. Toxicity from treatment was similar, as was the risk for secondary cancers and the cosmetic appearance of the breast.
However, researchers also looked at how this played out in smaller sub-populations and found that rates of recurrence
were nearly identical for women with DCIS, regardless of whether they received whole or partial breast irradiation. This was also true for women with breast cancer classified as low-risk stage I based on the American Society for Radiation Oncology (ASTRO) clinical guidelines.
Researchers showed that, in this sub-segment of breast cancer patients, the likelihood of recurrence 10 years posttreatment was very low overall and almost identical between women who received whole breast irradiation (2.3%) and partial breast irradiation (2.7%).
Julia White, MD, co-principal investigator of the national trial and head of breast radiation oncology at the OSUCCC – James, says this is very important because it reduces the burden of care for women who can still
achieve cancer control with fewer treatments over a shorter time.
“A significant portion of the breast cancer patient population nationally—about 25,000 to 30,000 women—would qualify
for partial breast irradiation. This is tremendously important because it allows us to give women the right amount of treatment for their disease and potentially allows better access to effective breast conservation for those who live far from a radiation facility,” White says. “Partial breast irradiation in five consecutive days versus whole breast, which can involve four to six consecutive weeks of multiday treatment, is effective and significantly less burdensome for patients. There is no denying that the five-day treatment is less costly and disruptive to life.”
At the OSUCCC – James, breast radiation is delivered in the face-down (prone) position to reduce radiation exposure in the chest wall, which has been linked to increased risk of heart and lung disease
post-cancer treatment.
To learn more about breast cancer research and care at the OSUCCC – James, visit cancer.osu. edu/breastcancer or call 800-293-5066.