Sept. 22, 2008 -- A breast cancer treatment
protocol that involves just one week of radiation instead of six or seven
looked highly promising in a four-year follow-up study, researchers say.
If proven as effective as conventional radiation, the procedure, known as
accelerated partial breast irradiation (APBI), could make breast conservation a
more attractive option for early stage patients who now choose mastectomy to avoid
Only about half of women who are good candidates for breast-conserving
surgery have it, and it is clear that lack of access to radiation facilities
and length of radiation treatment are contributing factors.
"Some women live hundreds of miles from a radiation center or they feel
they can't take seven weeks off from their jobs," Dallas breast surgeon
Peter D. Beitsch, MD, tells WebMD. "These women often end up having
Accelerated Radiation Controversial
Approved by the FDA in 2002, the accelerated radiation protocol evaluated in
the study is not widely used for the treatment of breast cancer.
Instead of irradiating the whole breast, the treatment focuses radiation at
the site of the removed tumor using a special single balloon catheter that
delivers the radiation through tiny radioactive seeds.
"It is fair to say that the technique is controversial in the radiation
and oncology community, in part because we haven't had good long-term follow-up
data on the patients who have had it," Beitsch says.
In an effort to address this concern, Beitsch and colleagues are following
patients who have had the partial breast irradiation.
They reported on outcomes among the first 400 women in their registry Monday
at the annual meeting of the American Society for Therapeutic Radiology and
Oncology in Boston.
About four years after treatment, a little more than 2% of these early-stage
patients who had breast-conserving surgery followed by the weeklong radiation
regimen had recurrences of their cancer.
This recurrence rate is similar to that seen with more conventional
whole-breast radiation, Beitsch says.
"Obviously, we will know more when we have been following these patients
longer, but the early follow-up data are encouraging," he says.
Radiologist Phillip M. Devlin, MD, of Brigham and Women's Hospital,
Devlin is chief of the division of brachytherapy at Brigham and Women's and
an assistant professor of radiation oncology at Harvard Medical School.
"These are preliminary results, but they suggest that outcomes for
carefully selected patients are as good as those with full breast
radiation," he says.
Careful Selection Is Key
Not all women with early-stage breast cancer are good candidates for the
partial breast irradiation protocol.
It is not considered appropriate for women who are younger than 45, have
tumors that are 3 cm or larger, have node-positive tumors, or who show evidence
of cancer cells at the margins of the tumor tissue removed during surgery.
Lobular tumors -- those that start in the milk-producing glands instead of
the milk ducts -- should also be treated with conventional radiation,
Even with these restrictions, Beitsch says the vast majority of patients
with early-stage breast cancers could have the accelerated radiation.
And Devlin says it is high time that more radiologists offer the protocol to
"The great shame of American medicine is that despite the data that this
seems to be a very safe treatment, today -- in 2008 -- the majority of women
who are eligible for breast-conservation surgery end up having mastectomies
because of access to care," he says.