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For Some Breast Cancer Patients, Shorter Radiation Works Well
Date:2/10/2010

Accelerated treatment yields similar results with less inconvenience, study finds

WEDNESDAY, Feb. 10 (HealthDay News) -- Women who need radiation after breast cancer surgery do just as well with three rather than five weeks of treatment, a new Canadian study suggests.

"We consider this [finding] a win-win situation, both for women with breast cancer and the health-care system," said study author Dr. Timothy J. Whelan, head of radiation oncology at McMaster University in Hamilton, Ontario.

Women can have a shorter, more convenient treatment schedule, he said, and the course of treatment is less costly to them and their health-care providers.

Though shorter, the three-week schedule used in the study involved a more intense dose of radiation. But the researchers found that the women -- who all had breast-conserving surgery, in which only part of the breast is removed -- could expect similarly low rates of recurrence and comparable cosmetic results.

Previous studies have shown that up to 30 percent of women in North America who have breast-conserving surgery do not undergo the recommended breast radiation, citing inconvenience or cost, Whelan and his fellow researchers wrote in a report on the study published Feb. 11 in the New England Journal of Medicine.

The study involved 1,234 women with invasive breast cancer who had a lumpectomy, which involves removing the cancerous lump and a small amount of normal tissue around it. After surgery, they either had the standard radiation treatment over a 35-day period or an accelerated treatment over 22 days.

About 10 years later, the risk for local recurrence of the cancer was 6.7 percent among the women who had gotten standard radiation treatment and 6.2 percent among those who'd gotten the briefer treatment, the study found.

Cosmetic outcomes were termed good or excellent in about 71 percent of the women in the standard-treatment group and 70 percent of the accelerated-treatment group.

The probability of survival at the 10-year mark was also similar: 84.4 percent for the standard group and 84.6 percent for the accelerated group.

Whelan said that, for some women, an accelerated schedule could be a welcome alternative.

"Some women are reluctant to have breast-conserving surgery because of the need to undergo the lengthy radiation treatment, typically six weeks," he said.

Another breast cancer expert said that she had also found positive results with shorter radiation treatments.

Dr. Manjeet Chadha, associate chairwoman of radiation oncology at Beth Israel Medical Center and associate professor of radiation oncology at the Albert Einstein College of Medicine in New York City, found that a three-week course of radiation works well for early-stage breast cancers.

She presented her findings in late last year at the annual meeting of the American Society for Radiation Oncology.

But she cautioned that while the new finding, coupled with her study's results, are promising, they don't apply to all women with breast cancer. Participants in Whelan's study, for instance, had to have negative axillary lymph nodes and clear resection margins.

What that study does reveal, she said, is "that in the node-negative patient, when you don't require chemo, you can get similar results with the abbreviated [course]."

But what is yet to be researched thoroughly, she said, is how well the shorter radiation course works for women who have breast-conserving surgery and do need chemo. About 11 percent of the women in Whelan's study also had chemotherapy.

Even so, Chadha said, the new study is important "because it does present an alternative for early-stage breast cancer patients."

More information

The American Cancer Society has more on radiation therapy.



SOURCES: Timothy J. Whelan, M.D., professor, oncology, and division head, radiation oncology, McMaster University, Hamilton, Ontario, Canada; Manjeet Chadha, M.D., associate chairwoman, radiation oncology, Beth Israel Medical Center, and associate professor, radiation oncology, Albert Einstein College of Medicine, New York City; Feb. 11, 2010, New England Journal of Medicine


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