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How to weigh the benefits, risks of radiation therapy for breast cancer
Beth Galvin – October 3, 2023
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Atlanta – Treating cancer means deciding whether to go with chemotherapy, surgery, radiation, or all or a combination of the above.
“It is very dependent on your particular cancer, and one thing I think the patients should just understand is that no cancer is the same,” says radiation oncologist Dr. Courtney Pollard with Peachtree Radiation Oncology Services, which contracts with Piedmont Healthcare.
Dr. Pollard says the cancer community is always looking for ways to do more with less.
“We’re always trying to make sure that we’re not over-treating folks, whether that be with surgery, radiation or chemotherapy,” Pollard says. “But, all 3 should be looked at as potentially areas where we can ‘de-escalate’. And we’re always trying to fine tune, to make sure we get a less treatment for the best outcomes.”
That is because the same treatment tools that are most effective at treating many cancers — chemotherapy, surgery and radiation therapy — can cause short term and long term negative side effects.
Chemotherapy can trigger pain, fatigue, nausea, anemia, weight changes and other side effects.
In patients with breast cancer or cancers in their chest, radiation therapy can target and destroy malignant cells, but it can also damage healthy heart tissue and blood vessels.
In some patients, that damage can raise the risk of heart disease down the road.
“But, I think it’s a little bit of a misnomer to say that radiation is either falling out favor with patients, or there’s a certain group of doctors that are advising against radiation, because radiation is still a necessary arm in many, many cancers,” Dr. Pollard says.
Breast cancer patients with early stage, lower risk cancers are typically offered breast-sparing surgery followed by radiation therapy and then 5 years of endocrine therapy, taking a daily pill to try to lower their risk of a recurrence.
But, in the LUMINA Study, published recently in the New England Journal of Medicine (NEJM), researchers found women age 55 and older with low risk luminal A breast cancer were able to safely skip radiation therapy after breast surgery, taking the hormone-blocking pill alone, with a low risk of recurrence at the 5-year-mark.
“Now, that’s a great result,” Dr. Pollard says. “It shows that we can de-escalate therapy for a certain type of low risk patient. Now, there’s many, many different types of breast cancer, and we have to be very careful with saying that this is going to be applicable to the wide population of breast cancer patients. But, that very specific subset, it looks like it might be beneficial.”
In their summary in the NEJM article, the study authors write, “Our study showed that women 55 years of age or older with T1N0, grade 1 or 2, luminal A breast cancer had a very low risk of local recurrence at 5 years after breast-conserving surgery when treated with endocrine therapy alone. The prospective and controlled nature of this study supports our conclusion that such patients are candidates for omission of radiotherapy.”
Dr. Pollard says the study, which followed nearly 500 women at 26 Canadian cancer centers, had some limitations.
“It’s a single-arm study,” he says. “So, they only looked at patients that received one sort of therapy. It was not a comparison trial.”
Navigating your cancer treatment options can be challenging.
If you’re newly diagnosed, Dr. Pollard says, find a cancer center that takes a multidisciplinary approach to deciding how to treat you.
Most academic and larger cancer centers have moved to a team approach to treating patients, he says, holding tumor boards that meet regularly to discuss each patient’s options.
“What that means is that patient who has a specific cancer is being evaluated by a doctor that prescribes chemotherapy, a surgeon that can remove their tumor, and a radiation oncologist who can radiate the tumor if it’s necessary,” Pollard explains. “Also, part of the discussion is many other folks: pathologists, diagnostic radiologists, geneticists, therapists. It’s a conglomerate to make a unified best decision for a patient.”