Full dose radiotherapy to whole breast may not be needed in early breast cancerMarch 09, 2016
Radiotherapy to the whole breast is standard treatment after breast-conserving surgery for women with early breast cancer, even those who have a low risk of the disease returning in the breast (local relapse). However, whole breast radiotherapy can cause changes in the appearance of the breast, which may also be firmer and tender to the touch, resulting in psychological distress.
"So we considered it important to set up a trial to answer the question: is full dose radiotherapy to whole breast needed in patients with low risk early breast cancer?" Dr Charlotte Coles, MD, Consultant Clinical Oncologist at Cambridge University Hospitals NHS Trust, Cambridge, UK, told the 10th European Breast Cancer Conference (EBCC-10) today (Wednesday). "One group of women received standard full dose radiotherapy to the whole breast. A second group received standard full dose to breast tissue closest to where the lump appears and a slightly lower dose further away. A third group received standard full dose radiotherapy to breast tissue closest to where the lump appears but no radiotherapy dose apart from this.
"We found after five years that rates of local relapse (the reappearance of a cancer after treatment in the breast where it was originally detected) were very low in all treatment groups, including those receiving less radiotherapy. Moderate and marked changes in normal breast tissue were also low across all groups. Follow-up is ongoing and ten-year local recurrence rates will be reported at a later stage," she said.
Dr Coles and colleagues from 30 radiotherapy centres across the UK, led by researchers at The Institute of Cancer Research, London, recruited 2018 patients aged over 50 who had had breast conservation surgery for invasive early breast cancer tumours measuring less than 3cm at their largest point. They were randomised into three groups: 675 had whole breast radiotherapy at the standard dose of 40 Gy* to the whole breast (the control group), 674 had 40 Gy to the tumour bed and 36 Gy to the rest of the breast, and 669 had 40 Gy to the tumour bed only; the latter two "test" groups being two ways of focusing radiotherapy to the tumour bed and giving lower or no dose to the rest of the breast.
All patients were treated with intensity modulated radiotherapy (IMRT), a technique that can deliver an even dose of radiation, thus minimising the chances of hotspots of unwanted high doses and reducing the cosmetic problems that can occur after breast radiotherapy. The characteristics of the three groups were very similar and the average age was 63 years.
"Five years after treatment, we found very low rates of local recurrence and minimal side effects across all the groups. We also found evidence of benefit to patients in the 'test' groups in terms of satisfaction with overall breast appearance as reported by patients themselves, particularly for those receiving no radiotherapy outside the tumour bed. However, we intend to continue to follow up the trial patients for at least ten years because we know that cancer recurrence can still occur more than five years after completion of treatment. It may be that no dose outside the tumour bed (partial breast radiotherapy) is sufficient for many patients, but some dose at a lower level than that given to the tumour bed is more appropriate for others," said Dr Coles.
The researchers believe that, in addition to minimising hotspots, the use of radiotherapy focused around the tumour bed with IMRT benefits patients because it spares part of the breast from either a full or any dose to the rest of the breast.
This form of IMRT is a simple, quick and cheap technique, which can be carried out with all standard radiotherapy equipment. It is now standard practice in the majority of radiotherapy centres Europe. "The radiotherapy beams have a glancing orientation that covers the breast but limits the dose to the lung and also the heart in left-sided breast cancers. There is, therefore, no concern about a higher volume of low dose radiation to normal tissue, which is sometimes a worry in more complex types of IMRT," said Dr Coles.
In addition to the ten-year follow-up, the researchers also intend to investigate in more depth the patient-reported outcome measures (PROMS). In addition to specific questions about the patient's breast and related symptoms, where outcomes have already been shown to be at least as good if not better than with whole breast radiotherapy, they also include more general questions about quality of life. "This is another area where we would expect to see better results from the 'test' groups," said Dr Coles.
"We hope that the evidence of benefit we have shown in this trial will bring about a change in practice worldwide, and enable very many more women with early breast cancer to undergo this treatment. At a time when breast cancer mortality rates are falling and more women are surviving their cancer, we believe it is particularly important to keep any treatment toxicity to the absolute minimum," she concluded.
Chair of the conference, Professor Fatima Cardoso, Director of the Breast Unit of the Champalimaud Clinical Centre in Lisbon, Portugal, said: "Over-treatment is a problem in cancers with a low risk of recurrence. This important study shows that, at least at five years follow-up, radiotherapy focused around the tumour bed with the IMRT technique provides as good local control as whole breast radiation and is associated with fewer side effects. This may, indeed, lead to a change in practice with benefits for patients and society, since it will also reduce costs. Longer follow-up is needed, however, since low-risk breast cancer has a long natural history."
Abstract no: 4 LBA. "Partial breast radiotherapy for women with early breast cancer: First results of local recurrence data for IMPORT LOW (CRUK/06/003) Wednesday, 14.45hrs, Keynote Lecture and Late Breaking Abstracts, Elicium.
ECCO-the European CanCer Organisation
Related Cancer Articles:
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Continuing PLOS Medicine's special issue on cancer genomics, Christos Hatzis of Yale University, New Haven, Conn., USA and colleagues describe a new subtype of triple negative breast cancer that may be more amenable to treatment than other cases of this difficult-to-treat disease.
Osaka University researchers revealed that the metabolite D-2-hydroxyglurate (D-2HG) promotes epithelial-mesenchymal transition of colorectal cancer cells, leading them to develop features of lower adherence to neighboring cells, increased invasiveness, and greater likelihood of metastatic spread.
University of Hawai'i Cancer Center researchers have identified an essential driver of tumor cell invasion in glioblastoma, the most aggressive form of brain cancer that can occur at any age.
University of Hawai'i Cancer Center researchers developed a computational algorithm to analyze 'Big Data' obtained from tumor samples to better understand and treat cancer.
University of Oklahoma researchers will apply a new analytical technology that could ultimately provide a powerful tool for improved treatment of cancer patients in Oklahoma and beyond.
Researchers have found that treating patients who have early stage non-small cell lung cancer with a type of radiotherapy called stereotactic body radiation therapy is associated with a small but increased risk of death from causes other than cancer.
Is investment in research to develop new treatments the best approach to controlling cancer?
The University of Illinois Cancer Center and Governors State University have received a joint four-year, $1.5 million grant from the National Cancer Institute to help both institutions conduct community-based research to reduce cancer-related health disparities in Chicago's south suburbs.
The Cancer Research Institute, the Association for Cancer Immunotherapy, the European Academy of Tumor Immunology, and the American Association for Cancer Research will join forces to sponsor the first International Cancer Immunotherapy Conference at the Sheraton New York Times Square Hotel in New York, Sept.
Related Cancer Reading:
The Emperor of All Maladies: A Biography of Cancer
by Siddhartha Mukherjee (Author)
Winner of the Pulitzer Prize, and now a documentary from Ken Burns on PBS, The Emperor of All Maladies is a magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence.
Physician, researcher, and award-winning science writer, Siddhartha Mukherjee examines cancer with a cellular biologist’s precision, a historian’s perspective, and a biographer’s passion. The result is an astonishingly... View Details
Cancer: My Unseen Gift: Unwrap a New Mindset
by Danny Torres (Author), AJ Mihrzad (Foreword)
"CANCER: MY UNSEEN GIFT" is a powerful true story and guide to help others change their mindset and never give up in any aspect of life, from health to wealth and beyond. I believe you can hack your cells to live a better, longer, healthier life. You can change your mindset at any given time once you challenge your belief system. When I was told I had only a couple of years left to live at age twenty-four, life stopped for a moment. I was suddenly staring death in its face and had so much more to give with my life. I decided to fight and win. This book is my story. It will help you with... View Details
F*ck Cancer: A totally inappropriate self-affirming adult coloring book (Totally Inappropriate Series) (Volume 4)
by Jen Meyers (Author)
*A portion of the proceeds from this book will be donated to support research dedicated to finding a cure for cancer. Because fuck cancer.
This book is for you.
If you are fighting cancer, this is for you. If your brother, sister, mom, dad, son, daughter, relative, or friend is fighting cancer, this is for you. If you've lost someone to cancer like I have, this is for you. If cancer affects your life in any way, this is for you.
The stress of cancer can feel crushing. But perhaps this book can help you get away from it all, if only for a little... View Details
The Cancer-Fighting Kitchen, Second Edition: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery
by Rebecca Katz (Author), Mat Edelson (Author)
This new and revised edition of the IACP award-winning cookbook brings the healing power of delicious, nutritious foods to those whose hearts and bodies crave a revitalizing meal, through 150 new and updated recipes.
Featuring science-based, nutrient-rich recipes that are easy to prepare and designed to give patients a much-needed boost by stimulating appetite and addressing treatment side effects including fatigue, nausea, dehydration, mouth and throat soreness, tastebud changes, and weight loss. A step-by-step guide helps patients nutritionally prepare for all phases of... View Details
Tripping over the Truth: How the Metabolic Theory of Cancer Is Overturning One of Medicine's Most Entrenched Paradigms
by Travis Christofferson (Author), Dominic D'Agostino (Foreword)
With a new foreword by Dr. Dominic D'Agostino, PhD and epilogue by the author
A masterful synchronization of history and cutting-edge science shines new light on humanity's darkest diagnosis.
In the wake of the Cancer Genome Atlas project's failure to provide a legible roadmap to a cure for cancer, science writer Travis Christofferson illuminates a promising blend of old and new perspectives on the disease. Tripping over the Truth follows the story of cancer’s proposed metabolic origin from the vaunted halls of the German scientific golden age to... View Details
The Truth about Cancer: What You Need to Know about Cancer's History, Treatment, and Prevention
by Ty M Bollinger (Author)
Cancer touches more lives than you may think. According to the World Health Organization, one out of three women alive today, and one out of two men, will face a cancer diagnosis in their lifetime.
To Ty Bollinger, this isn’t just a statistic. It’s personal. After losing seven members of his family to cancer over the course of a decade, Ty set out on a global quest to learn as much as he possibly could about cancer treatments and the medical industry that surrounds the disease. He has written this book to share what he’s uncovered—some of which may shock you—and to give you... View Details
Cancer: 50 Essential Things to Do: 2013 Edition
by Greg Anderson (Author)
The ground-breaking classic guide to surviving cancer?now completely updated!
Revised and updated for the first time since 1999, this invaluable guide to cancer recovery offers an easily accessible plan for patients and family members. Written by a cancer survivor, the book is an inspiring, action-oriented roadmap for those who choose to adopt a stance of hope and take charge of their diagnosis.
With penetrating insights that bring together more than two decades of scientifically supported research and experience, Anderson reveals a step-by-step holistic action plan... View Details
Anti-Cancer Smoothies: Healing With Superfoods: 35 Delicious Smoothie Recipes to Fight Cancer, Live Healthy and Boost Your Energy
by Linda H. Harris (Author)
Anti-Cancer Diet, Cancer Fighting Foods, and Cancer Nutrition
Whether you have cancer or you're at risk of cancer because of your family history - the way you eat can have a major impact on your health and your ability to fight or manage your disease. Cancer is notorious for sapping the strength and nutrition out of a person's body. You'll need to replace a lot of the vitamins, nutrients and minerals that certain drugs and treatments deplete.
The Anti-Cancer Smoothies in this book are made of healthy and tasty vegetables, fruits, spices and herbs that are known to fight cancer.... View Details
Anticancer: A New Way of Life
by David Servan-Schreiber MD PhD (Author)
The revolutionary, New York Times bestselling guide to the powerful lifestyle changes that fight and prevent cancer—an integrative approach based on the latest scientific research
“A common-sense blueprint for healthy living.” —Chicago Tribune
“Resonating with cancer support communities and recommended nationwide.” —Los Angeles Times
“Life affirming . . . filled with practical advice.” —The Seattle Times
David Servan-Schreiber was a rising... View Details