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Radiation 'Boost' Prevents Breast Cancer Relapse

Study shows common therapy is the right way to go

MONDAY, Nov. 12, 2001 (HealthDayNews) -- If you have a tumor removed from a breast, chances are good that you'll get several rounds of radiation and then an extra dose directed at the area where the cancer was found. For years, doctors have just figured it was the right thing to do. Now a European study shows that the additional "boost" will indeed help prevent the disease from coming back.

"This confirms that what we're doing is the right way to go," says Dr. Lawrence Margolis, a professor of radiation oncology at the University of California at San Francisco.

Breast cancer treatment didn't always offer much beyond radical surgery. Just a few decades ago, women with breast cancer had no choice but to undergo mastectomies, in which all, or a large part of, a breast was removed. "If you just took the mass out without doing something else, the rate of recurrence was as high as one in three," says Dr. Stephen Seagren, a radiation oncologist at the University of California at San Diego.

But researchers outside the United States began experimenting with radiation therapy after only the lumps were removed, and they found a much lower rate of problems.

"The whole idea is that some of the cancer cells have wandered off into the area of the breast, so you have to treat the rest of the breast somehow," says Dr. Matthew Spear, a radiation oncologist who also works at the University of California at San Diego.

As radiotherapy became more accepted as a way to prevent recurrence and save the breast itself, doctors turned to the issue of how much radiation to use, Seagren says. Doctors in the United States gave extra treatment to the tumor areas but didn't know for sure that it was beneficial, experts say.

In the new study, researchers examined more than 5,300 European women who had undergone lumpectomies and ordinary radiation treatment. Of those women, 2,661 were given extra radiation treatment to the area of the breast where the tumors were removed.

Among patients age 40 or under, the percentage who had a recurrence of breast cancer in the same area over a five-year period was 19.5 percent if no extra radiation was given. The rate dropped to 10.2 percent for those who did get an additional dose.

The results weren't as good for women older than 40, but the researchers still suggested that the extra dose be given to women between 41 and 50.

The findings by the European Organization for Research and Treatment of Cancer appear in the Nov. 8 issue of the New England Journal of Medicine.

Radiation has risks, of course. Seagren says there is always a "tradeoff" between increasing radiation levels and dealing with more side effects.

Radiation can cause scarring and change the appearance of treated breasts. The European researchers noted that the breasts treated with an extra dose were more likely to look less than "excellent" or "good" on a cosmetic level.

But the researchers -- along with Seagren, Margolis and Spear -- say the extra dose is worth the risk. The additional treatments mean just less than two weeks of daily five-minute treatments, Margolis says.

"It's easily done, and there's very little in the way of side effects, either short-term or long-term," he says.

What To Do

Learn about different types of treatment options for breast cancer from the American Society for Therapeutic Radiology and Oncology. You can also read this primer on radiation -- including how to handle the side effects -- from the National Cancer Institute.

Learn about breast cancer basics in this Q&A from the Susan G. Komen Breast Cancer Foundation.

SOURCES: Interviews with Stephen Seagren, M.D., radiation oncologist, professor of medicine and radiology, University of California, San Diego, Medical School; Matthew Spear, M.D., assistant professor of radiation oncology, University of California, San Diego, Medical School; Lawrence Margolis, M.D., professor of radiation oncology, University of California, San Francisco; Nov. 8, 2001, New England Journal of Medicine
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