Radiation Therapy for Breast Cancer: Three New Studies

What's new in breast cancer radiation therapy news? Last week we added three studies on radiation to the LATESTBreastCancer.com database and website. Topics include postmastectomy radiation, radiation of the axilla and heart related side-effects.

Radiation after mastectomy reduces recurrence rates in women with large breast tumors

An August 20 study from MD Anderson in the International Journal of Radiation Oncology, Biology Physics examined recurrence rates of 162 patients with clinically T3N0 tumors who were treated with neoadjuvant (before surgery) chemotherapy and mastectomy. 'T3' means the tumors were larger than 5 cm. 'N0' means there was no lymph node involvement. (For some of the patients, pathological evaluation later revealed lymph node involvement.)

The study revealed that women who also received postmastectomy radiation were less likely to experience a local-regional recurrence (LRR) than those who did not receive radiation. Postmastectomy radiation reduced recurrence rates in women with and without lymph node involvement. Accordingly, the authors suggested that postmastectomy radiation be considered for women with T3N0 breast cancer.

Whole breast radiation is sufficient to prevent lymph node recurrence after sentinel lymph node procedure

An August 31 study in Cancer from the Memorial Sloan-Kettering Cancer Center evaluated the effectiveness of whole breast irradiation in preventing lymph node recurrence in 326 women with positive sentinel lymph nodes (SLNs) who did not undergo axillary lymph node dissection. Instead of removing all lymph nodes in the axilla area, only the sentinel lymph nodes were removed. 93% received some sort of radiation therapy.

After 4 years, 3 of the 326 women experienced a lymph node recurrence. Two of them received radiation in the standard supine (face-up) position. One did not receive radiation at all. There was no lymph node recurrence among the 66 who received radiation in the prone (face-down) position.

The authors concluded that regional control was high (99% at 4 years) in women with low-volume sentinel lymph node disease, "regardless of whether the axilla was irradiated." They noted,

"Whole-breast radiation alone, including in the prone position, is sufficient treatment after breast-conserving surgery for select patients with tumor-containing SLNs who omit axillary dissection."

Risk of cardiovascular disease after radiation is greater in older women with left-side breast cancer

An August 30 study in Cancer Epidemiology, Biomarkers & Prevention evaluated the risk of cardiovascular disease in 806 women over 65 with early stage breast cancer.

As a group, radiotherapy was not associated with a greater risk of cardiovascular disease. However, among women who received radiation, those who were treated for cancer of the left breast had a significantly increased risk of cardiovascular disease compared to those with right-side breast cancer.

The authors concluded that laterality (the side of treatment) "is critical to understanding the effect of" radiotherapy on cardiovascular disease. "As some irradiation to the heart is unavoidable, . . . continued effort is required to minimize such exposures, especially in older women with left-sided tumors."

To see all the latest news and research on radiation therapy for breast cancer, please visit the LATESTBreastCancer.com website. Click on the "Treatments" tab and search for "radiation" or "postmastectomy".

The Breast Cancer Research Update: July 14

Today in breast cancer research news, we'll highlight recent studies in two controversial areas - nipple-sparing mastectomy and treatment for small, node-negative breast tumors.

Nipple-sparing mastectomy can be safe in properly selected patients

As the name implies, the intent of a nipple-sparing mastectomy is to remove breast tissue and spare the natural nipple area. As noted in a July 5 study published in Plastic and Reconstructive Surgery, the procedure "remains controversial and its adoption has been slow because of oncologic and surgical concerns."

The Georgetown University researchers evaluated the safety of nipple-sparing surgery in 48 women who had 49 mastectomies to treat a current breast cancer and in 80 women who had 113 mastectomies to prevent breast cancer.

In the treatment group, 80% (39/49) of the procedures included subareolar biopsies. 10% (4/39) revealed DCIS, resulting in the later removal of the nipple area. Four breasts had ischemic (blood supply) complications in the nipple area. One of those resulted in excision. On follow-up, an average of two and a half years later, no patients developed cancer in the nipple area.

In the prevention group, 71% (80/113) of the procedures included subareolar biopsy. One biopsy revealed LCIS. No DCIS or invasive cancer was found. Two nipple areas which developed ischemic complications were later excised. On follow-up, an average of three and a half years later, no primary cancers developed in the nipple area.

The authors concluded that nipple-sparing mastectomies "can be safe in properly-selected patients." Subareolar biopsies can effectively identify cancerous cells and ischemic complications can be minimized.

Treatment of early breast cancer

The treatment of early stage (small, node-negative) breast cancer often involves difficult decisions. Options included mastectomy, breast conserving surgery plus radiation and the possible addition of chemotherapy to either surgical option. Two recent studies shed light on when radiation and chemotherapy should be considered. Both can be found on the breast conserving surgery (lumpectomy) page of the LATESTBreastCancer.com website.

Breast conserving surgery plus radiation for early triple-negative breast cancer

A June 13 study in the Journal of Clinical Oncology, discovered that women with early stage(T1-T2, node-negative) triple-negative breast cancer treated with mastectomy alone had a "significant increased risk" of local recurrence when compared with those treated with breast conserving surgery plus radiation. The authors concluded that future studies of radiation therapy after mastectomy for triple-negative breast cancer are warranted.

Chemotherapy should be considered for young patients with early breast cancer

A July 5 MD Anderson study published in The Breast Journal noted that some patients with small, node-negative tumors who only undergo local therapy, such as breast conserving surgery, experience recurrences. The researchers analysed data from 273 patients to identify prognostic factors. They discovered that age at diagnosis was a significant factor in predicting recurrence. They concluded that "adjuvant systemic therapy," such as chemotherapy, "should be discussed with and considered for young patients" with small, node-negative invasive breast cancer.

Please check back tomorrow for more updates from LATESTBreastCancer.com. As always, all the latest news and research on any breast cancer test or treatment option may be found on our website anytime.

The Breast Cancer News Update: June 6

This weekend, there were several interesting breast cancer research developments from the American Society of Clinical Oncology (ASCO) meeting in Chicago.

Aromasin for breast cancer prevention

Perhaps the biggest news from ASCO this weekend was the study which found that Aromasin (exemestane) reduces the risk of breast cancer for post-menopausal women without the potentially lethal side effects of tamoxifen or Evista (raloxifene). The Los Angeles Times, New York Times, Reuters and others covered the story. (I even saw coverage on my local TV news station this morning.) In the study, hot flashes, fatigue, insomnia and bone stiffness were slightly more common among women on Aromasin. Pfizer's patent on Aromasin expired on April 1, which is expected to reduce the cost of treatment.

Zometa plus hormone therapy reduces the risk of breast cancer recurrence

Austrian researchers discovered that, for premenopausal women with early-stage, hormone receptor positive breast cancer, adding the osteoporosis drug Zometa (zoledronic acid) to tamoxifen or Arimidex (anastrazole) reduces risk of recurrence more than taking tamoxifen or Arimidex alone. The joint pain, bone pain and fever side-effects were relatively mild.

Axillary radiotherapy reduces the risk of breast cancer recurrence

For women with early-stage breast cancer with one to three positive lymph nodes, a Canadian study found that radiation therapy to the breast and axillary lymph nodes reduced the risk of distant recurrence more than radiation to the breast alone. The Globe and Mail and Medical News Today covered the story. Side effects included lymphedema and lung inflammation.

NKTR-102 shows clinical benefit as a second or third-line for metastatic patients

Positive results from a phase II trial reveal a clinical benefit for NKTR-102 as second or third-line therapy for metastatic patients. Neuropathy and alopecia were minimal. Phase III studies are planned.

Flaxseed is not effective against hot flashes

Finally, not all news from ASCO this weekend was good. According to a Mayo Clinic study, flaxseed is not an effective remedy for hormone therapy related hot flashes.

At LATESTBreastCancer.com, we'll continue to follow breast cancer news developments daily. As always, we welcome feedback and comments.