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The combination of breast-conserving surgery and irradiation is accepted as a locoregional treatment alternative to mastectomy, for women with early-stage breast cancer, and results from modern studies indicate that this approach is associated with a very low probability of disease recurrence.

The success of radiation in minimizing the risk of recurrence for women treated with a breast conserving surgery was highlighted by Dr. Thomas Buchholz, of The University of Texas M. D. Anderson Cancer Center, Dept of Radiation Oncology, in an article published this week in The New England Journal of Medicine, “Radiation Therapy for Early-Stage Breast Cancer after Breast-Conserving Surgery.”

Clinical evidence on breast-conservation therapy “began in the 1970s, [and the] 20-year rate of local recurrence was reduced from 39% without radiation therapy to 14% with radiation therapy.” Radiation came to be coupled with breast-conservation surgery because removing just the tumor was not enough to rid of the cancer cells in the long run, and complete removal of tissue did not guarantee a non-recurrence either because “microscopic disease that if left untreated could develop into recurrent disease,” which brought the patient back to square one.

The National Comprehensive Cancer Network and the American College of Radiology have established treatment guidelines based from phase III trials, which were reviewed by Dr. Buchholz, and he found that these studies, “led both organizations to recommend breast-conserving therapy with whole-breast irradiation as an appropriate treatment option for patients with early-stage disease.” He also added that, “the outcome for patients who are treated with breast-conserving surgery has continued to improve, and the risk of local recurrence is now less than that reported in the initial clinical studies.”

Furthermore, the advances in radiation oncology technologies have also reduced the risks and adverse effects of treatment. The planning of radiation treatments is now routinely done with CT-treatment planning techniques, which permit the radiation oncologist to view targets and normal tissues with a three dimensional relationship to radiation dose. This can help minimize unnecessary radiation delivery to normal structures such as the heart and lung. Most patients receiving the 5-6 week course of treatment still have some side effects but in general these are mild. Side effects of fatigue and a skin reaction similar to a sun burn develop towards the end of the treatment course and are self-limited. There can also be a cosmetic effect on the breast as there is “volume loss, fibrosis and retraction at the tumor-bed site.”

The article also notes that “the sophisticated techniques, associated with a 6-week course of treatment can range from $25,000 to $50,000, depending on the specifics of the case.” Though much of it is paid by health insurance, this treatment can be a hardship for those who currently not under coverage. Therefore, it is likely that a request to shorten the timeframe of the treatment might also have something to do with the costs of the procedure.

In addition to topical effects, Dr. Buchholz also mentioned that there is sometimes a limitation for patients in terms of resources (some travel out of state for treatment, or long distances, some are elderly) and on their availability, as the timeframe is generally at a 5 week minimum, beginning after the surgery recuperation time period ends. Due to these factors, “investigators in the UK and Canada have conducted clinical trials comparing treatment over 3 weeks rather than 5 weeks,” which Dr. Buchholz notes in his article that, “the initial results of these trials have been promising.” However, in our interview with Dr. Buchholz, he expressed concern over shortening the time frame to an even quicker treatment course as the “healthy cells which are also being subjected to radiation need time to repair.”