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Study Backs Short, Intense Radiation for Breast Cancer

Study finds it as effective as standard, longer course

TUESDAY, Aug. 6, 2002 (HealthDayNews) -- When it comes to radiation therapy for breast cancer, slow and steady doesn't always win the race.

New research finds a shorter, more intense course of radiation after a lumpectomy seems to be equally effective as the standard course, which is longer but with less radiation each time.

Although experts agree that radiation therapy after surgery to remove a malignant tumor reduces the risk of a recurrence, there's no consensus on how long that treatment should last.

Currently, most treatments last for four to six weeks. In the new study, appearing in tomorrow's issue of the Journal of the National Cancer Institute, researchers gave patients modestly higher bursts of radiation for only three weeks.

"This shorter treatment is going to be a lot more convenient for women," says Dr. Timothy Whelan, study author and an assistant professor of medicine at McMaster University in Hamilton, Ontario. "The other thing from the health-care perspective is that you can reduce the cost by half almost, so the ramifications are really huge."

This is not a new treatment for breast cancer, experts say.

"We've probably known for some time that we can probably speed up radiation a little bit, but I don't think that's where the action is," says Dr. Alan J. Stolier, medical director of the Lieselotte Tansey Breast Center at the Ochsner Clinic Foundation in New Orleans. Cutting-edge research these days involves localized radiation, such as brachytherapy, which targets the tumor rather than the whole breast.

On the other hand, shortening conventional radiation therapy has the advantage of being something many women can take advantage of now.

"In Canada, we consider this a win-win situation for women and for the health-care system," Whelan says. "This is standard treatment for women now. I think it's a big breakthrough. You could have this tomorrow. Tomorrow, you could reduce your treatments by half."

In this study, Whelan and his colleagues randomized 1,234 women who had undergone lumpectomies for their breast cancer into two different treatment arms. One received the more intensive radiation (30 percent more) over 22 days, and the other received the conventional, less intensive radiation over 35 days. None of the cancers had spread to the lymph node.

After six years of follow-up, there appeared to be no difference in recurrence of the breast cancer or in cosmetic outcome. Local recurrence-free survival was 97.2 percent in the "short" group and 96.8 percent in the "long" group.

The authors counsel, however, that the shorter therapy is not recommended for women with very large breasts.

Should this new course of radiation therapy become the new standard? The authors of an editorial in the same issue of the journal give a qualified "yes." Women who have small tumors that have been successfully removed might benefit.

At the very least, the findings expand the range of options.

"I think we're going to end up with a menu," Stolier says. "It's great to have more than one choice, and we can select certain choices that take into account the characteristics of patients and their tumor, but also the [professional] skills that happen to be available."

What To Do

For a fact sheet on radiation therapy, visit the National Cancer Institute. For an overview of the disease, try the American Cancer Society.

SOURCES: Timothy Whelan, M.D., assistant professor, medicine, McMaster University, Hamilton, Ontario; Alan J. Stolier, M.D., medical director, Lieselotte Tansey Breast Center, Ochsner Clinic Foundation, New Orleans; Aug. 7, 2002, Journal of the National Cancer Institute
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