'Focused' Radiation Could Lighten Treatment Burden for Early Breast Cancer
Wendy Lybarger lived an hour's drive from the hospital where her breast cancer would be treated, so she was looking forward to a heaping helping of hassle.
For as many as six weeks, she'd have to travel there every weekday to receive radiation treatments after surgery to remove the small lump in her breast.
But then her doctor offered her another option -- more focused and frequent radiation therapy over just five days.
"It kind of sounded too good to be true," said Lybarger, 58, a pastor living in Dayton, Ohio. "My first question was, it sounds good but is it as good? I don't want to give up effectiveness of treatment for convenience."
The answer is yes, it is as good, but only for select women at low risk of recurrence, according to clinical trial findings presented Monday at the American Society of Clinical Oncology's annual meeting, in Chicago.
For three decades, standard treatment has been to expose the entire breast to radiation beams daily, Monday through Friday, for between three to six weeks, said co-lead researcher Dr. Julia White. She is head of breast radiation oncology at the Ohio State University Comprehensive Cancer Center, in Columbus, Ohio.
"If you work or have little kids or don't live near a radiation center, that daily trek for weeks is a barrier," White said.
Advances in early detection and radiation therapy led White and her colleagues to ask if a shorter, more intense round of treatment might do just as well in women whose breast cancer had been caught early.
"We can give higher doses over a shorter period of time safely," White said. "We treat just about 30% of the breast around where the tumor used to lie, and we do it quickly over five days."
Doctors tested this approach in 4,200 women who underwent lumpectomies after being diagnosed with early-stage breast cancer at hospitals across the United States.
These women were randomly assigned to undergo either standard whole-breast radiation for the full round, or the more intense and shorter partial-breast radiation.
Partial-breast radiation was doled out in 10 sessions over five days, with at least 6 hours' recovery between the same-day sessions, White said.
Results were generally favorable across-the-board -- both sets of women had recurrence rates under 5% over 10 years, with survival rates around 90%, White said.
The two radiation strategies "weren't quite equivalent" for all women, however, White said. Whole-breast radiation performed slightly better when it came to cancer recurring, about 1% better than partial-breast radiation.
But in a certain group of women who were at very low risk -- over age 50, with hormone-sensitive tumors and lymph nodes showing no signs of the cancer spreading -- the partial-radiation therapy performed just as well as traditional treatment, White said.
"When we examined those women, the average recurrence rate was at 2% to 3% at 10 years," White said. "That's awesome, right? Ninety-seven percent with either treatment had no recurrence."
That means as many as 25,000 to 30,000 women every year could be eligible to receive the shorter, more intense therapy, White explained.
"That's nothing to sneeze at," White said. "That's a substantial percentage."
White believes that accelerated partial-breast radiation therapy should be offered as an option for women like Lybarger.
Lybarger said her tumor wound up being around 1.4 centimeters when surgically removed, and genetic testing showed she was at low risk for recurrence. She was diagnosed in early August 2018 during a regular mammogram.
Lybarger received her radiation treatments on a Wednesday-to-Friday, Monday-to-Tuesday schedule.
At the end of her 10th treatment, Lybarger packed her car from the hotel room where she'd stayed overnight in Columbus and drove home, where she facilitated a meeting that very evening.
"That night I was back in a local church doing a meeting, and did a staff meeting the following morning," Lybarger said. "I've felt fine ever since."
Not all doctors share such a rosy view of this accelerated radiation schedule, however.
Dr. Richard Bakst, a radiation oncologist at Mount Sinai in New York City, said he's concerned about how well the technique compares to full-breast radiation.
"It's unclear to me if it's efficacious," Bakst said. "I don't think this is a game changer by any means. I don't think it should be widely adopted at this point."
Research presented at meetings should be viewed as preliminary until published in a peer-reviewed journal.
The American Cancer Society has more about treatment options for breast cancer.
SOURCES: Wendy Lybarger, pastor, Dayton, Ohio; Julia White, M.D., head, breast radiation oncology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio; Richard Bakst, M.D., radiation oncologist, Mount Sinai, New York City; June 3, 2019, American Society of Clinical Oncology annual meeting