One of the main drawbacks of radiation therapy is the frequency and length of the treatment. Therefore, new techniques that shorten the course of treatment are being studied in clinical trials. The results of the trials will decide whether these therapies become part of standard care. After talking with your health care provider, it is important to consider participating in a clinical trial of radiation therapy for breast cancer.
For more information, see the Clinical Trials section.
For information on promising, new treatments for metastatic breast cancer, visit the Emerging Areas in Metastatic Breast Cancer section.
Accelerated Whole-Breast Therapy
Accelerated whole-breast therapy is similar to standard radiation therapy except that it uses a slightly higher dose of radiation per session. This allows for a shortened course of therapy. Only a few studies have been done on the procedure, but results are promising [10-12]. Results from a Canadian randomized trial found that women who got an accelerated three-week course of therapy did as well in terms of cancer recurrence as those who got a more standard five-week course of treatment [12]. The safety and benefits of this technique, however, need to be confirmed by other trials. Also unclear are the long-term side effects of increasing the dose per session. One large study of radiation therapy suggested that higher doses per session may increase the risk of death by conditions like heart disease [13].
Accelerated Partial Breast Irradiation
Accelerated partial breast irradiation delivers radiation only to the area around the tumor bed (the surrounding tissue and empty space left after the tumor has been removed during lumpectomy). This reduces the number of radiation sessions. Partial breast irradiation might eliminate the need to give radiation to the entire breast over a five- to seven-week period, the current standard for radiation therapy.
Accelerated partial breast irradiation can be done by brachytherapy, conformal external beam or by intraoperative radiation therapy. Accelerated partial breast irradiation is being studied only among women with lymph node-negative, early breast cancer who meet certain criteria concerning age, tumor size and margin status.
Brachytherapy
Brachytherapy is a way of delivering partial breast irradiation that uses targeted radiation therapy placed inside the tumor bed. Implanted radiation "seeds" (interstitial radiation therapy) or a single small balloon device (intracavitary radiation therapy) can be used to deliver the radiation. In brachytherapy, because radiation is limited to the area around the tumor bed, the course of treatment is only one week. Some studies have shown that accelerated partial breast irradiation with brachytherapy may be as effective in reducing rates of recurrence as whole breast radiation therapy [14,15]. However, follow-up time on these studies is still short. Brachytherapy is still under study and is not standard care at this time. It should only be considered as part of a clinical trial.
Conformal external beam radiation therapy
Conformal external beam radiation therapy uses standard external beam radiation to target only the tumor bed. Similar to brachytherapy, a limited area of the breast receives radiation. Treatment can be completed in about one week.
Intra-Operative Radiation Therapy
Intra-operative radiation therapy is similar to brachytherapy in that radiation is delivered to the tumor bed in higher doses than would be given during a standard radiation therapy session. The main difference is that with the intra-operative procedure only a single dose of radiation is given during a lumpectomy. In contrast, standard radiation is given in multiple treatments (called fractions) about a month after surgery. As with brachytherapy, intra-operative radiation therapy is an experimental procedure that needs further study before its risks and benefits are known. At this time, it is being studied mainly in Europe.
Updated 08/24/09
