Nav: Home

Full dose radiotherapy to whole breast may not be needed in early breast cancer

March 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."
-end-
*A Gray (or Gy) is a measure of ionising radiation dose. One Gray is the absorption of one joule of energy, in the form of ionising radiation, per kilogram of matter.

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:

Radiotherapy for invasive breast cancer increases the risk of second primary lung cancer
East Asian female breast cancer patients receiving radiotherapy have a higher risk of developing second primary lung cancer.
Cancer genomics continued: Triple negative breast cancer and cancer immunotherapy
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.
Metabolite that promotes cancer cell transformation and colorectal cancer spread identified
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.
UH Cancer Center researcher finds new driver of an aggressive form of brain cancer
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.
UH Cancer Center researchers develop algorithm to find precise cancer treatments
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.
New analytical technology to quantify anti-cancer drugs inside cancer cells
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.
Radiotherapy for lung cancer patients is linked to increased risk of non-cancer deaths
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.
Cancer expert says public health and prevention measures are key to defeating cancer
Is investment in research to develop new treatments the best approach to controlling cancer?
UI Cancer Center, Governors State to address cancer disparities in south suburbs
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.
Leading cancer research organizations to host international cancer immunotherapy conference
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)

The Truth about Cancer: What You Need to Know about Cancer's History, Treatment, and Prevention
by Ty M. Bollinger (Author)

The Cancer-Fighting Kitchen, Second Edition: Nourishing, Big-Flavor Recipes for Cancer Treatment and Recovery
by Rebecca Katz (Author), Mat Edelson (Author)

Chris Beat Cancer: A Comprehensive Plan for Healing Naturally
by Chris Wark (Author)

F*ck Cancer: A totally inappropriate self-affirming adult coloring book (Totally Inappropriate Series) (Volume 4)
by Jen Meyers (Author)

Anticancer: A New Way of Life
by David Servan-Schreiber MD PhD (Author)

Keto for Cancer: Ketogenic Metabolic Therapy as a Targeted Nutritional Strategy
by Miriam Kalamian EdM MS CNS (Author), Thomas N. Seyfried (Foreword)

The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies
by Dr. Nasha Winters ND FABNO L.Ac Dipl.OM (Author), Jess Higgins Kelley MNT (Author), Kelly Turner (Foreword)

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)

Cancer: Step Outside the Box
by Ty M. Bollinger (Author)

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Circular
We're told if the economy is growing, and if we keep producing, that's a good thing. But at what cost? This hour, TED speakers explore circular systems that regenerate and re-use what we already have. Guests include economist Kate Raworth, environmental activist Tristram Stuart, landscape architect Kate Orff, entrepreneur David Katz, and graphic designer Jessi Arrington.
Now Playing: Science for the People

#504 The Art of Logic
How can mathematics help us have better arguments? This week we spend the hour with "The Art of Logic in an Illogical World" author, mathematician Eugenia Cheng, as she makes her case that the logic of mathematics can combine with emotional resonance to allow us to have better debates and arguments. Along the way we learn a lot about rigorous logic using arguments you're probably having every day, while also learning a lot about our own underlying beliefs and assumptions.