For those diagnosed with breast cancer, radiation treatment is often a necessary component of treatment. But why is it important? A randomized control study conducted by Dr. Bernard Fisher in 1976 discovered that patients who had a lumpectomy and breast radiation treatment had a 14.3% cumulative incidence of breast tumor recurrence compared to a 39.2% incidence of recurrence in patients who had lumpectomy without radiation. Therefore, in patients with early stages of breast cancer, lumpectomy followed by radiation therapy was established as the standard of care for breast conservation.
Traditional methods of radiation therapy involve whole breast irradiation to the affected and typically lasts five days weekly for about 6 weeks. Although it is effective, it is time-consuming and is associated with various side effects such as swelling, itchiness, and skin changes (redness and peeling). Long-term side effects may include scarring of the lungs, heart, and muscle.
We now understand that breast cancer recurs within about 2cm, or 3/4″, of the original tumor bed. As a result, researchers developed newer therapy techniques to deliver radiation to the target area, while minimizing treatment time and damage to local tissues. A great alternative to whole breast irradiation in early breast cancer patients is using SAVITM brachytherapy. SAVITM utilizes an in-office implanted device to deliver radiation from the inside out over five days. During each treatment, small radioactive pellets are briefly inserted through the device into the cavity to deliver a burst of radiation.
In women with early-stage breast cancer, this alternative is known as accelerated particle breast irradiation and has been shown to be just as effective as whole breast irradiation, all while improving cosmetic results. Five-year results comparing 5-day Brachytherapy to who;e breast irradiation showed a recurrence rate of 1.44% and 0.92%, respectively.
A 2018 prospective study of 73 women who received a shorter 2-day treatment course and were followed for 14 months reported minimal adverse effects, and excellent cosmesis in 95%. A 2022 retrospective study of 17 patients reported no local cancer recurrence in 95.8% of patients at 22 months.
Though additional studies are required, in women with early-stage breast cancer and lumpectomy, there may be a role for a 2-day course of radiation.
References:
Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002 Oct 17;347(16):1233-41. doi: 10.1056/NEJMoa022152. PMID: 12393820.
Simon, L. E., Scanderbeg, D., Einck, J., Mayadev, J., Brown, D., Wallace, A., Blair, S., Yashar, C., & Huynh-Le, M.-P. (2022). Retrospective review of three-fractioned accelerated partial breast irradiation. Brachytherapy, 21(4), 487–493. https://doi.org/10.1016/j.brachy.2022.02.002
Strnad et al., (2016). 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: A randomised, phase 3, non-inferiority trial. The Lancet, 387(10015), 229–238. https://doi.org/10.1016/s0140-6736(15)00471-7
