Are we doing too many Rads?

FloridaLady · March 2009

I have seen a couple articles lately on this. I have not heard much talk about it?? They found this out seven years ago and nothing seems to be done about. Again why?

Breast Cancer Radiation Treatment: Less May Be As Good As More

Article date: 2002/08/07

Radiation helps prevent cancer from coming back after the removal of a cancerous lump from the breast. It is the standard, recommended treatment for women after lumpectomy.

Radiation treatments may take five to six weeks following surgery, and that causes problems for many women.

Now, new research shows that as little as three weeks of treatment would work just as well. Timothy Whelan, radiation oncologist from the Hamilton Regional Cancer Centre in Ontario and colleagues reported their findings in the Aug. 7 Journal of the National Cancer Institute (Vol. 94: 1143-50).

Dose And Schedule Tested

The researchers pointed out that there is wide agreement that breast radiation prevents the recurrence of breast cancer following lumpectomy.

But there is less agreement among different centers in the US, Canada, Britain, and France as to the schedule and doses of radiation treatments used to treat breast cancer after lumpectomy.

To find out which dose and schedule worked best, the researchers performed a study where women with breast cancer received one of two radiation treatment schedules.

One group of women was treated with a standard treatment program of radiation with 25 treatments over 35 days (about five weeks). The other group received a short course treatment schedule of 16 radiation treatments over 22 days, or about three weeks total.

The standard dose group did receive a greater total amount of radiation (about 20% more) than the short course group. However, the dose for each treatment was larger for the short course group of women.

A total of 1,234 patients were studied, with about half receiving short course treatment, and the other half the standard long course. None of the women had lymph nodes involved with breast cancer.

No Real Difference Shown In Outcome

After looking at the results of the study, the authors concluded that there were no real differences between the outcomes of the two treatment programs.

A total of 44 women representing both groups had the cancer come back in the breast as the first evidence of cancer recurrence. There was no difference in the frequency of breast recurrence between the two groups.

The results were also the same for the appearance of the breast, side effects, cancer recurrence, and the survival of the patients.

The schedule and dose of radiation treatment made no difference. Both groups did the same.

The authors said this is the first randomized trial to compare a shorter, rapid schedule with a longer, traditional schedule for breast radiation after lumpectomy.

The study results supported the use of a shorter schedule for women with lymph node-negative breast cancer treated by lumpectomy, said the authors.

Does Not Apply To All Women

But the researchers also warned that there are some women to whom these results do not apply. In particular, this would include women with large breasts who may be prone to poor cosmetic effects of radiation given in larger doses over shorter periods of time.

But for women who have declined radiation after surgery because of the long treatment times or other problems such as work or family commitments, their findings are important.

A shorter schedule "will lessen the burden of treatment for women, many of whom may also receive adjuvant chemotherapy, and will have important quality-of-life benefits with respect to convenience and less time away from home and work," the doctors said.

Other Experts Agree

Carolyn I. Sartor, MD, and Joel E. Tepper, MD, from the department of radiation oncology at the University of North Carolina School of Medicine in Chapel Hill, N.C., agreed with this statement by Whelan. Sorter and Tepper commented on this study in an editorial in the same journal (1114-1115).

"Patterns-of-care studies show that, although more patients are being treated with breast-conserving surgery, the use of radiotherapy in this setting is declining," said Sartor and Tepper. This may be due to insurance, race, income, and distance from radiotherapy centers, they noted.

The results of this trial show that in "carefully selected patients, use of shorter, less expensive, and more convenient radiotherapeutic approaches can produce excellent local control of breast cancer with acceptable cosmesis [that is, the appearance of the breast after radiation is completed]," said Sartor and Tepper.

They pointed out that many of the women in the study had small cancers, and that the results can't be applied to women with large breasts or those with ductal carcinoma in situ [who were not treated as part of this study].

It is important to realize, said Sartor and Tepper, that there is much research going on in this area. Trying to find the right dose of radiation, given in shorter courses and with different devices and schedules, may further decrease the time women have to devote to their radiation treatments after they have breast cancer surgery.

"It is premature to generalize these results beyond the categories of patients actually treated in the trial, but, with further technologic and biologic advances, perhaps we can ultimately do even 'less,' " they said.

Reached for comment, Sartor said, "The important message is that this is a really well done paper. We just can't underestimate the role of randomized trials such as this in helping us learn about our treatments."

Sartor also underscored that other short course or limited treatments that are currently under investigation must be considered experimental until they meet the same standards of proof of the Whelan study.

"These are purely experimental, new techniques," Sartor said of other investigational short course treatments. "They don't stand up to the same level of scrutiny that the Whelan study does."

As to applying the short course treatment described in the report to her own practice, Sartor said that many radiation oncologists, including herself, have been using this approach on some of their patients already. This is done especially when patients come from long distances or have other difficulties committing to longer treatment courses, she said.

"This increases my confidence that it is safe and effective" in women who have the stage of breast cancer treated in this study, Sartor said.

FloridaLady · March 2009

Less Radiation for Breast Cancer Works

New Method Can Shave 2 to 3 Weeks off of Conventional Radiation Therapy By Charlene Laino
WebMD Health News Reviewed by Louise Chang, MD

June 4, 2007 (Chicago) -- A new way of delivering radiation can safely shave two to three weeks off the conventional treatment of women with early breast cancer, a European study suggests.

"The findings suggest that women can safely undergo a less demanding course of radiation therapy without appearing to increase their risk of recurrence," says researcher John A. Dewar, MD, a clinical oncologist at the University of Dundee in Scotland.

Additionally, the short course appears to cause fewer side effects, including breast shrinkage or swelling, and hardening of the breast tissue, he tells WebMD.

The findings were presented at the annual meeting of the American Society of Clinical Oncology.

Low Breast Cancer Recurrence Rates in All Groups

The study included nearly 4,500 women that had successfully undergone surgery to remove their breast tumors.

All the women received surgery and then underwent conventional external beam radiation therapy, designed to prevent recurrences. The method involves aiming a beam of X-ray radiation through the chest and under the arm to kill cancer cells.

Some women received the standard treatment of 50 Grays, the unit used to measure radiation, in 25 treatments spread over five weeks.

The others were given about 40 Grays -- either in 15 treatments over three weeks or in 13 treatments every other day for five weeks.

By about five years later, cancer had come back in 5% or fewer of women in all the groups.

Finding Potentially Practice-Changing

The results are "very exciting news for our patients," some of whom have to travel hundreds of miles to receive the conventional radiation regimen, says Julie Gralow, MD, assistant professor of oncology at the University of Washington in Seattle.

She notes that in the U.S., women are often given a booster, bringing the total length of therapy to six to seven weeks.

"This is very disruptive to your life," Gralow tells WebMD. "If we can give less radiation, either by giving it over three weeks or by giving it every other day, that's a big advantage."

Gralow says she believes the findings are potentially practice-changing.

Some of the radiation oncologists at her institution have already indicated that they think it's a good idea, she says. Plus, "patients will push for it."

U.S. Testing Another Breast Cancer Short Course

Gralow notes that doctors at Fox Chase Cancer Center in Philadelphia are testing yet another way of delivering a short course of radiation.

That method is called intensity modulated radiation therapy, or IMRT. In IMRT, multiple radiation beams are focused at the breast from many directions. A computerized program allows doctors to adjust both the strength and the intensity of the beams so that more radiation is blasted at the tumor site and less is delivered to surrounding healthy tissue.

Additionally, the doctors added a radiation boost, a little each day, to the part of the breast where the tumor was removed.

As with the European method, the American method appears to be just as effective and perhaps safer than conventional therapy.

FloridaLady · March 2009

Briefer radiation treatment effective for early breast cancer: study

Last Updated: Monday, September 22, 2008 | 4:54 PM ET CBC News The findings could change how early-stage breast cancer is treated in North America, says Dr. Timothy Whelan. (CBC) Shorter courses of radiation therapy work just as well as the longer standard therapy for women with early-stage breast cancer, according to the results of a Canadian-led trial.The researchers randomly assigned 1,234 women to be treated with either three weeks of a more intensive radiation to the whole breast or the standard five weeks of radiation to the whole breast.Currently, many women with early-stage breast cancer have a lumpectomy to remove the cancer, followed by radiation therapy to kill any remaining cancer cells. The standard radiation treatment takes about 15 minutes a day, Monday through Friday, for five weeks."We were surprised that the risk of local recurrence and side-effects for women treated with accelerated whole breast irradiation was so low even at 12 years," said the study's lead author, Dr. Timothy Whelan, a radiation oncologist at McMaster University in Hamilton."Our study shows that this treatment should be offered to select women treated with early-stage breast cancer."Although the shorter approach is more intensive, the total dose of radiation is slightly reduced, Whelan said.The shorter approach is also more convenient because patients don't need to take as many trips to the cancer centre.At Monday's annual meeting of the American Society for Therapeutic Radiology and Oncology in Boston, Whelan presented the findings of the 12-year study that concluded the accelerated approach was equally effective in terms of breast cancer recurrence.At 10 years after treatment, cancer returned locally in 6.2 per cent of patients treated with the accelerated radiation therapy, compared with 6.7 per cent for those patients treated with standard therapy, the researchers found.Whelan said he expects the findings will change the way early-stage breast cancer is treated in North America.Both groups of women also had excellent or good cosmetic outcomes from the radiation treatments, the researchers said.The shorter treatment, called accelerated hypofractionated whole breast irradiation, is two-thirds of the cost of the standard whole breast radiation, according to the researchers. It is also less expensive than other approaches such as partial breast irradiation.The findings will also help cut wait times for radiation therapy, said Dr. Ida Ackerman, a radiation oncologist at Toronto's Sunnybrook Health Sciences Centre. Ackerman wasn't among the authors of the study, but she did enrol some patients in the '90s."It means that we can see and treat more women with the same resources that we have in a timely fashion," said Ackerman, who has been using the shorter approach for qualified patients.A large trial has begun across Canada looking at shorter, more intensive treatment given in a week to just part of the breast.

Are we doing too many Rads?

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