Notes

New findings indicate that three
weeks of radiation treatment
works just as well as the more common
five weeks for women with early-stage
breast cancer, according to Canadian
researchers who followed a large cohort for 12 years. The findings could
change the standard of care in the United States.
Typically, treatment for this type of
cancer takes five to seven weeks of daily treatments. About 180,000 women a
year develop breast cancer in the United
States, and most require radiation. About
30%–40% would be candidates for the
type of treatment used in this study.
The women in the study had early cancers that were removed by lumpectomy
and that had not spread to the lymph
nodes. The study involved 1,234 women
who started treatment at one of eight
hospitals from 1993–1996. Half of the
women received the standard 25 treatments in 35 days, and the other half had
16 treatments in 22 days. The shorter
course used slightly higher doses of radiation, but the total cumulative dose
was slightly lower.
After 10 years, no significant differences were found between the groups.
Both had recurrence rates of 6%–7%
and had good or excellent cosmetic outcomes. The results provide evidence
that radiation schedules at clinics can
be shortened, reducing the burden on
patients, reducing waiting lists, and allowing more women to be treated without buying more machines.
Other changes in radiation treatment
also are being studied. Some physicians
are experimenting with ways to treat
just part of the breast rather than all of
it and trying to avoid exposing the heart
and lungs to radiation. One technique
has patients treated lying on their stomachs instead of the usual way, on their
backs. The women lie on a mattress
with an opening for the breast to fall
forward, which minimizes the amount of
radiation to the heart and lungs, reducing the risk of coronary artery disease
and lung cancer.
Other medical centers are experimenting with techniques to shorten the
treatment to a few days or even just one
day. Those techniques involved treating
about a quarter of the breast nearest
the tumor with the radiation given by a
machine or implanting radioactive seeds
into the space left by the lumpectomy.
Sometimes the entire dose of radiation
is given before the patient has left the
operating room. Partial-breast treatments are still being studied, and more
follow-up is needed.
These changes are being brought
about, in part, by the success in treating
breast cancer. Survival rates are now
so high, with 98% of women with earlystage breast cancer living five years or
longer, that it is possible to try modifying treatments to improve women’s
quality of life. The researchers hope
that faster treatment will make radiation available to more women, especially
those who work, live far from a center,
or have small children, making it difficult for them to travel back and forth for
multiple treatments.