Interesting study on Radiation treatment

"What is really exciting about this study is that it gives us a much more complex understanding of the interaction of radiation with cancer cells that goes far beyond DNA damage and cell killing," Pajonk said. "The study may carry enormous potential to make radiation even better."

Pajonk stressed that breast cancer patients should not be alarmed by the study findings and should continue to undergo radiation if recommended by their oncologists.

"Radiation is an extremely powerful tool in the fight against breast cancer," he said. "If we can uncover the mechanism driving this transformation, we may be able to stop it and make the therapy even more powerful."

"a meager local recurrence advantage"? Not for me. In my case it's far more than meager.

You mean the FISHER et al. that says this:

CONCLUSION: In women with tumors ≤ 1 cm, IBTR occurs with enough frequency after lumpectomy to justify considering XRT, regardless of tumor ER status, and TAM plus XRT when tumors are ER positive.

Or the one that says this:

CONCLUSION Through 8 years of follow-up, our findings continue to indicate that lumpectomy plus radiation is more beneficial than lumpectomy alone for women with localized, mammographically detected DCIS. When evaluated according to the mammographic characteristics of their DCIS, all groups benefited from radiation.

Or the one that says this:

CONCLUSION The reduction of breast cancer deaths suggests that radiation therapy may have a value beyond the clearly established improvements obtainable for local control. Use of techniques that minimize cardiac dose is important in reducing the risks of adjuvant radiotherapy, especially in good-prognosis patients.

 While I agree with you that the studies never supply a clear-cut answer for the individual, until we have that ability, radiation therapy is proving - time and again - to be beneficial in preventing both local recurrence and - to a lesser degree - metastatic recurrence.

Actually, in Canada, a study is ongoing that suggests - via interim results - that overall survival of early breast cancer patients receiving regional node radiation (even if they have less than a 5 centimetre tumour and 3 positive nodes), long-term survival IS affected.  That's why, in Canada, it is now standard-of-care to offer such radiation to early-stage breast cancer patients and not just advanced stage.  Interim results have found that there is a 2% increase in long-term survivability, i.e., 2% of patients who opt for such radiation have not had a metastatic recurrence when compared to the opt-out group.  And, thus far, heart problems have not been at issue.

http://www.medscape.com/viewarticle/743992

And while conclusions may be editorial, they DO have to jive with the facts just presented.  Which the conclusions do.  As someone who has actually drafted/edited such reports, I know this. 

Addendum: many times a study's conclusions absolutely contradict the findings so as to pass standard of care-driven peer review.

The most aggregious example of this is lack of logic is the study on FNA needle biopsies seeding cells to the nodes when compared with sterotactic procedure. The conclusions summarily reported that there was no reason to change standard of care in light of the findings.

Seriously. Look that one up.

My data is accurate. And checkable. That's the Gold Standard.

Best wishes to you for a healthy life.

I agree with SelenaWolf that one study on its own, especially one that is not a large, long-term clinical trial cannot be considered evidence.  There have been advantages reported for disease free survival and overall survival for certain subsets of women who have had mastectomies to receive radiation to their regional nodes and chest wall.  The Canadian study which SelenaWolf is referring to is only one.  In fact, there was one recently posted (link below) on this website that showed an overall survival advantage of treating the neck and chest lymph nodes.  The second article summarizes some of the literature and the fact that this is still a gray area for treatment.

http://www.breastcancer.org/research-news/20131023

http://www.onclive.com/publications/obtn/2013/april-2013/Deciding-When-Post-Mastectomy-Radiation-Therapy-Is-Warranted

I don't think anyone was referring to "one study." Some studies are still ongoing since cardiac death or disease often shows up 15-20 years later. I was referring to all known studies specifically where radiotherapy was used as adjuvant therapy post lumpectomy.

Clarification: Post mastectomy radiotherapy is another issue. I've followed the scientist on the St. John's listserv who was investigating post mast rads for his wife who had a mass near the chest wall. These stats are a mish-mash because the subjects were so widely varied in their pathology reports and other treatments. In situations like this it's difficult to recruit a homogenous study population using identical radiotherapy guidelines.

Natty, I was referring to the "one study" that is posted at the beginning of this thread.  These conclusions do not jive with the overall and diease-free survival benefits that have been seen in many properly executed clinical trials for radiation.  The Canadian study has been going on for over 20 years.  Furthermore, radiation treatments have become much more sophisticated/targeted over those 20 years, so cardiac side effects should continue to decrease.  There are many good reasons to skip radiation based on specific risks/benefits but I'm not convinced the study at the beginning of this thread is one of them. 

This is from a meta-analysis in The Lancet (Nov. 2011):

"Overall, radiotherapy reduced the 10-year risk of any (ie, locoregional or distant) first recurrence from 35·0% to 19·3% (absolute reduction 15·7%, 95% CI 13·7–17·7, 2p<0·00001) and reduced the 15-year risk of breast cancer death from 25·2% to 21·4% (absolute reduction 3·8%, 1·6–6·0, 2p=0·00005). In women with pN0 disease (n=7287), radiotherapy reduced these risks from 31·0% to 15·6% (absolute recurrence reduction 15·4%, 13·2–17·6, 2p<0·00001) and from 20·5% to 17·2% (absolute mortality reduction 3·3%, 0·8–5·8, 2p=0·005)",

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254252/

It appears both recurrence and absolute mortality are reduced by radiotherapy. But I will admit that the study posted by jojo did give me pause. It made me wonder if I would be trading a lower chance of recurrence in the short-term for an increased chance of metastatic cancer long-term. But it is important to keep in mind it is a study in cells, not in people.

Digger, I would hope we could have an honest exchange of opinion without being directed to confine ourselves to one portion of the forums.

Background: The British Columbia randomized radiation trial was designed to determine the survival impact of locoregional radiation therapy in premenopausal patients with lymph node–positive breast cancer treated by modified radical mastectomy and adjuvant chemotherapy. Three hundred eighteen patients were assigned to receive no further therapy or radiation therapy (37.5 Gy in 16 fractions). Previous analysis at the 15-year follow-up showed that radiation therapy was associated with a statistically significant improvement in breast cancer survival but that improvement in overall survival was of only borderline statistical significance. We report the analysis of data from the 20-year follow-up.

Methods: Survival was analyzed by the Kaplan–Meier method. Relative risk estimates were calculated by the Wald test from the proportional hazards regression model. All statistical tests were two-sided.

Results: At the 20 year follow up (median follow up for live patients: 249 months) chemotherapy and radiation therapy, compared with chemotherapy alone, were associated with a statistically significant improvement in all end points analyzed, including survival free of isolated locoregional recurrences (74% versus 90%, respectively; relative risk [RR] = 0.36, 95% confidence interval [CI] = 0.18 to 0.71; P = .002), systemic relapse–free survival (31% versus 48%; RR = 0.66, 95% CI = 0.49 to 0.88; P = .004), breast cancer-free survival (48% versus 30%; RR = 0.63, 95% CI = 0.47 to 0.83; P = .001), event-free survival (35% versus 25%; RR = 0.70, 95% CI = 0.54 to 0.92; P = .009), breast cancer-specific survival (53% versus 38%; RR = 0.67, 95% CI = 0.49 to 0.90; P = .008), and, in contrast to the 15-year follow-up results, overall survival (47% versus 37%; RR = 0.73, 95% CI = 0.55 to 0.98; P = .03). Long-term toxicities, including cardiac deaths (1.8% versus 0.6%), were minimal for both arms.

Conclusion: For patients with high-risk breast cancer treated with modified radical mastectomy, treatment with radiation therapy (schedule of 16 fractions) and adjuvant chemotherapy leads to better survival outcomes than chemotherapy alone, and it is well tolerated, with acceptable long-term toxicity.

http://jnci.oxfordjournals.org/content/97/2/116.short

This seems pretty clear-cut to me. 

Natty, a completely different patient group compared to what? The original study posted did not look a t a specific group, and people seemed to conclude from it that rads should be avoided in all cases. Are you now saying that there are patients for whom rads may be advantageous, in spite of the risks?

Then you're going to have to also name-call our host here at breastcancer.org "irresponsible" also since they reported the same conclusions I did. I'm not sure why you feel facts are harmful to people. Please trust people to make educated decisions. I appreciated someone saying she would take her chances with heart diseases rather than risk a local recurrence. That is an educated decision where the patient evaluates her own tolerance for choices.

See article below and overall survival at the end.

[article accessed from the breastcancer.org web site August 17, 2010]



http://www.breastcancer.org/treatment/radiation/new_research/20060217a.jsp





What breastcancer.org says about this article…Radiation Benefits Women with Small Cancers After

Lumpectomy



After lumpectomy alone with clear margins, chances are that you are cancer-free. But your doctor will talk

to you about treatment you can have just in case some cancer cells were left behind.

In this situation, getting the best breast cancer treatment can feel like a balancing act: You want to do as

much as you can to get the cancer out and lower the risk of it coming back. But you'd like to avoid

uncomfortable side effects that might lower your quality of life.



In this study, the researchers wanted to see if there was a group of women who could get just hormonal

therapy after lumpectomy and skip radiation therapy. So they looked at a group of post-menopausal

women whose cancers are the type associated with the most favorable outcomes:



hormone-receptor-positive,

smaller than three centimeters, and

node negative.

If you're in this group, you have a very low risk of the cancer coming back.



As these results show, even women with a very low risk of recurrence can benefit from radiation after

surgery. This means that so far, no group of women has been found that would NOT benefit from whole

breast radiation.



Remember that no single treatment plan is right for everyone. If you want to do everything possible today

to lower the risk of ever seeing the cancer again, then radiation after lumpectomy may be a very important

step for you. If you have a small cancer that has been removed with wide and clear margins of resection

and you're more concerned about how radiation will affect you, you may want to talk to your doctor about

skipping radiation and just taking hormonal therapy. Your risk of the cancer coming back in the same area

is likely to be higher, but how long you live will probably not be affected.



Instead of having whole breast radiation, you can also talk to your doctor about the potential role of partial

breast radiation. Studies are now under way to test the effectiveness of radiation delivered just to the area

around the cancer. This is called partial breast radiation. Promising results after four years of using this

approach have led to a clinical trial that is now comparing partial breast radiation to whole breast radiation.

The trial is called the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39 study. Talk to

your doctor—you may be able to enroll in the NSABP B-39 study.



Juggling risks that may affect your life can be very uncomfortable. You need to talk to your doctors and

family, and consider all your options, to decide on the plan that's right for YOU.



The February 2006 Research News section was made possible by an unrestricted educational grant from

Genentech BioOncology.



Research News on Radiation Therapy

ASCO: Radiation Short Course Now Breast CA Alternative

ASCO: Value of RT After Lumpectomy Questioned

Post-Mastectomy Radiation May Be Underused

SSO: Post-Mastectomy Radiation May Be Overused

Shorter Radiation Course Matches Standard for Breast Cancer

More Research News on Radiation Therapy (25 Articles)



Reviewed study: "Radiation Benefits Women with Small Cancers After Lumpectomy" by M. F. X. Gnant and

others, San Antonio Breast Cancer Symposium, December 8, 2005, Abstract 8



Is this for me? If you have small, early-stage invasive breast cancer and are wondering if you can skip

radiation after surgery, you might want to read this article.



Background and importance of the study: Breast-conserving surgery lumpectomy followed by radiation—

has become a standard treatment for women with breast cancers that:



are small to medium in size (usually four centimeters—about two inches—or less in diameter),

are limited to one place in the breast, and

can be removed with clean margins.



Radiation to the whole breast after lumpectomy has been recommended for all women who choose breast

conservation (instead of breast removal, or mastectomy), regardless of the women's age. This "standard

of care" recommendation is based on many large studies that compared lumpectomy plus whole breast

radiation to lumpectomy alone. These studies showed that radiation therapy after lumpectomy significantly

reduced the risk of the breast cancer coming back in the same breast.



The studies also found that women with node-negative disease lived equally long lives after lumpectomy

alone or lumpectomy plus radiation. Women with node-positive disease had an increase in survival. The

main benefit from radiation is to lower the risk that cancer might return in the breast, requiring more

surgery and possibly other treatments.



Other treatments may be given after surgery. Hormonal therapy is a medicine given after surgery for

hormone-receptor-positive breast cancer. Hormonal therapy:



lowers the risk of the cancer coming back,

improves survival after surgery, and

lowers the risk of developing breast cancer in the other breast.

With all these different types of post-surgery treatments, it would be helpful to know who needs radiation

treatment and who might do fine with hormonal therapy alone. Several studies have looked at whether

hormonal therapy offers enough protection against recurrence after lumpectomy for women with small

cancers—eliminating the need for radiation. This could spare some women the inconvenience, side

effects, and cost of radiation.



The study reviewed here continues to look at this important question. Keep in mind that ALL of the women

in this study had relatively small cancers and no lymph node involvement. They then received hormonal

therapy and about half received radiation too. So this study does not address the role of radiation alone

without hormonal therapy.



Study design: Austrian researchers used the results of two studies conducted by the Austrian Breast

Cancer Study Group (ABCSG) to identify groups of women who had an extremely low risk of recurrence

(the breast cancer coming back).



All the women were post-menopausal and had breast cancer that was:



hormone-receptor-positive,

smaller than three centimeters, and

node negative.

All the women had lumpectomy followed by different types of hormonal therapy:



In ABCSG-6, 698 women took tamoxifen with or without aminoglutehimide (an old-fashioned kind of

aromatase inhibitor).

In ABCSG-8, 875 women took either five years of tamoxifen or two years of tamoxifen followed by three

years of Arimidex (chemical name: anastrozole).

About half of the women in each study were randomly assigned to receive radiation after lumpectomy and

before hormonal therapy. The other half had lumpectomy followed by hormonal therapy—without radiation.



Results: After about 10 years of follow-up in the ABCSG-6 trial, the cancer came back in



3.3% of the women who had radiation, compared to

5.2% of the women who didn't receive radiation.

However, this difference was not significant, meaning it could be due to chance rather than due to the

radiation.



After about four years of follow-up in the ABCSG-8 trial, the cancer came back in



0.24% of the women who had radiation, compared to

3.2% of the women who didn't have radiation.

This difference was statistically significant, meaning that it was likely due to the radiation and not just to

chance.



There was no difference in overall survival in either trial between women

who had radiation treatment and women who did not.



Conclusions: The researchers concluded that radiation therapy to the whole breast can help reduce the

risk of recurrence in women with small hormone- receptor-positive breast cancers, even if they receive

hormonal therapy after lumpectomy.

"So, no, I am not comparing apples and oranges except in your mind. Locoregional radiation is clearly beneficial for early-stage women. It reduces local recurrence, it reduces distance recurrence, and with minimal cardiotoxicity. And a majority of the cardiotoxicity studies are seeking out ways to reduce this rare side-effect even further. Encouraging all women -regardless of stage, grade, menopausal status, health status, etc.- to avoid radiation, without consulting with their own treatment team, without encouraging them to ask questions and discuss the benefits vs. the risks of radiation for their particular situation, to continue to state that radiation "will kill you and lead to long-term heart damage" is simply irresponsible. I, especially, shudder at the fact that you continue to re-iterate such a viewpoint to women who come to these boards, newly diagnosed, frightened, overwhelmed by the sheer scope of information coming at them, desperately seeking assurance that they are going to be okay only to read that, something which may benefit them in both the short- and long-term is "going to kill them and lead to permanent heart damage". Frightening them further with such a biased interpretation, encouraging them to skip radiation, inferring that a radiation oncologist is, of course, going to downplay the dangers for them is... well, I have no words."

Excellent post Selena.. pretty much sums up my concerns with many of the alternative attitudes on here and not just about rads. And for what is worth, that stupid thread title " informed .....bla blabla .. there is a big difference between informed and well informed...or accurately informed. Well informed people tend to be open minded and look at all the evidence.. many on that threat are quite closed minded despite being alternative.

Most newbies don't understand that data findings don't go out of date. Data findings are a permanent record of studied subjects. The findings don't change. Please ask any scientist.

And regards to the name-calling, I understand that when people can't rebut an argument they attack the messenger with negative characterizing, demonizing, etc. Please try to stay positive in the interest of constructive dialogue. I respect your decision 100% and I know you mean well.

Holiday cheers!