MRI Helps Doctors Select Best Treatment for Early Breast Cancers
Nearly 10% of patients who had a breast MRI before completing breast conservation treatment had additional disease not originally seen on the patient’s mammogram, according to a study presented at ASTRO in Denver last month.

The results show that breast MRI enhances patient selection for accelerated, partial breast irradiation treatment by detecting previously unsuspected, microscopic lesions within the breast before treatment begins.

For patients with early-stage breast cancer, the current standard treatment involves surgery to remove the tumor followed by a course of external beam radiation to the entire breast over a six- to seven-week period. Alternatively, radiation oncologists are studying accelerated partial breast irradiation in a select group of women with early-stage breast cancer. The procedure reduces the radiation course to just one to five days.

In this study, doctors performed both standard mammography and also breast MRI to determine as accurately as possible the extent of the patient’s tumor, as well as the presence of any unsuspected disease elsewhere in the breast. Of the 51 patients reported, nearly 10% had additional cancer identified on the MRI that was not identified on the mammogram. The additional disease suggests that the patients were more safely treated with wider removal of breast tissue followed by whole breast radiation therapy, or mastectomy (surgical removal of the breast), in cases of biopsy-proven multicentric disease.

“At this point, we feel that partial breast irradiation is best reserved for women with unifocal carcinoma, excised with tumor-free margins, without evidence of multifocal or multicentric disease,” said Kathleen Horst, MD, lead author of the study and a radiation oncologist at the Stanford Cancer Center in Stanford, Calif. “Breast MRI may help radiation oncologists identify the most suitable candidates for this accelerated treatment to minimize the chance that a woman’s cancer will return near the original tumor or elsewhere in the breast.”

Annual Prostate Cancer Screening Test Appears to Save Lives
Men who have a yearly blood test to examine their prostate-specific antigen (PSA) levels are nearly three times less likely to die from prostate cancer than those who don’t have annual screenings, according to a study presented last month at ASTRO.

The study shows that over an estimated 10-year period, men who have an annual PSA test will have a 3.6% chance of dying from the disease, compared with 11.3% in the general population. Patients who have the test are more likely to be diagnosed with curable prostate cancer in the vast majority of cases.

“The PSA blood test is the best simple screening test available for prostate cancer that picks up prostate cancer earlier, while it’s still curable,” said Jason Efstathiou, MD, lead author of the study and a resident at the Harvard Radiation Oncology Program in Boston. A PSA test measures the level of PSA, a protein produced by the prostate. Increased levels of PSA may be a sign of prostate cancer.

The researchers followed 1,492 men who were treated for prostate cancer from 1988 to 2002 by the surgical removal of their prostate and whose cancer later came back. Among this group, 841 men had yearly PSA tests before their cancer diagnosis, while 611 men were diagnosed by other methods. (Large, randomized trials are currently underway in both the United States and Europe further evaluating the impact of PSA screening tests among prostate cancer patients.

Balloon Brachytherapy Shortens Rad Therapy to One Week
Accelerated partial breast irradiation using balloon brachytherapy makes it more convenient for breast cancer patients to receive radiation therapy after surgery and appears to be safe, offers good cosmetic results, and keeps cancer from returning, according to four-year results of an ongoing study presented last month at ASTRO.

“This radiation technique is an excellent option for women with early breast tumors, especially those who are unable to have the standard six-week course of radiation, due to time constraints,” said Martin Keisch, MD, lead author of the study and a radiation oncologist at Mount Sinai Comprehensive Cancer Center in Miami Beach, Fla. “There are 100,000 women per year in this country alone that could benefit from this treatment.”

Many women with breast cancer are able to undergo breast-conserving therapy to keep their breast after treatment. Typically, this means they have lumpectomy surgery followed by a course of radiation therapy to kill any remaining cancer cells. The standard radiation therapy treatment takes a few minutes each day, Monday through Friday, for five to seven weeks. Radiation oncologists are experimenting with ways to shorten the length of treatment.

In this type of breast brachytherapy, the doctor inserts a small balloon into the cavity created by the surgery. That balloon is then attached to a catheter to deliver high doses of radiation to the breast. The treatment reduces the amount of time required for radiation therapy from six weeks to one week. Brachytherapy is one of several methods of accelerated partial breast irradiation, treating only the area surrounding the tumor instead of the whole breast.

The multicenter, prospective trial involves 43 breast cancer patients who were treated with MammoSite brachytherapy and are being followed over a 10-year period. After a median time of 48 months from treatment, no patients have seen their cancer return and the cosmetic outcome was reported as “good-to-excellent” in 80% of the women.

Doctors Can Halve Dose of Radiation and Still Cure Hodgkin’s
Reducing the dose of involved field radiation therapy, combined with chemotherapy, can still effectively treat patients suffering from early-stage Hodgkin’s lymphoma, according to a German study presented at ASTRO last month.

If caught early, Hodgkin’s lymphoma can usually be cured and most patients are living many years after their diagnosis. However, they often must live with side effects caused by the treatment. In this study, doctors wanted to see whether they could reduce the amount of radiation given to patients to cut down on side effects and still cure them of their cancer.

“Although this was an interim study, the results are very encouraging that we can cure patients with early-stage Hodgkin’s lymphoma of their cancer while reducing the amount of radiation we give them, thus allowing them to have a higher quality of life after treatment,” said Hans Theodor Eich, MD, lead author of the study and a radiation oncologist at the University of Cologne in Cologne, Germany.

Between May 1998 and May 2002, Eich and colleagues studied 1,131 patients to see whether giving patients chemotherapy and reducing the amount of radiation from 30 Gray (Gy) to 20 Gy would cure their cancer. The results showed that more than 98% of patients receiving the reduced treatment experienced complete remission from their disease. Only 2.5% of the patients relapsed during the study’s two years of observation and 1.1% (13 patients) died from the disease during the course of the study.

Adding Chemo to Rad Therapy Before Surgery Controls Rectal Cancer
Receiving radiation therapy and chemotherapy before surgery, to shrink rectal tumors so they can be more easily removed, helps keep the cancer from returning, according to a study by French researchers presented at ASTRO last month.

“The standard treatment for rectal cancer has been radiation therapy alone before surgery, but this is the first randomized study to prove that adding chemotherapy to the treatment helps patients beat their cancer,” said Pascale Romestaing, MD, a coauthor of the study and radiation oncologist at CHU Lyon Sud in Lyon, France.

Beginning in 1992, doctors in France enrolled 733 patients suffering from rectal cancer into the study. The patients were split into two groups—the first received radiation alone for five weeks before undergoing surgery to remove the cancer and the second group received chemotherapy in addition to five weeks of radiation therapy prior to surgery.

The doctors discovered that while combining radiation therapy and chemotherapy does not significantly increase survival rates, it does improve local tumor control and helps keep the cancer from returning. The last phase of the trial, from 1999 to 2003, showed that only 8% of the patients saw their cancer return within five years after receiving treatment.

“This treatment should be recommended as the standard for the majority of rectal cancer patients,” said Jean-Pierre Gerard, MD, lead author of the study and a radiation oncologist at the Centre Antoine-Lacassagne in Nice, France.

Breast-Conserving Treatment an Option for Women With Implants, Findings Challenge Need for Mastectomy
Breast-conserving surgery followed by radiation therapy is a good option for women with early-stage breast cancer who have breast implants, according to a study presented at ASTRO last month.

“Past research was based on a small sample of patients and older radiation techniques,” said Rosalyn Morrell, MD, lead author of this Mayo Clinic study. “Therefore, we investigated a larger group of women treated with radiation using newer techniques that refuted the reports of poor cosmetic outcome among patients.”

The new findings challenge past studies that showed delivering radiation to a breast with an implant in place causes significant problems in the implant, resulting in poor cosmetic results.

Most women with early-stage breast cancer are able to undergo breast conservation surgery to keep their breast after treatment. Typically, this means they first have surgery to remove the cancer, followed by a course of radiation therapy to kill any remaining cancer cells. This approach is just as effective as a mastectomy in treating the cancer and is preferred by many women.

More women today are opting to have cosmetic breast implants. As women age, their risk of breast cancer increases, so a fraction of these women will eventually develop breast cancer. These are the patients who would be most interested in preserving their breasts and avoiding mastectomy.

Between 1994 and 2004, researchers reviewed the records of 26 breast cancer patients with previously augmented breasts who were treated with breast conservation surgery and radiation at the Mayo Clinic. All patients had their implants in place before their breast cancer diagnosis. Eighty-five percent of patients followed over a three-year period had favorable cosmetic results following radiation therapy. None of the patients in the study suffered a relapse of their cancer.

IMRT Helps Brain Cancer Patients Keep Their Hair
Patients whose cancer has spread to the brain can avoid typical hair loss when treated with newer radiation techniques—improving their quality of life while still controlling their cancer—according to a study presented at ASTRO last month in Denver.

Most cancer patients whose cancer has spread to the brain receive whole brain radiotherapy. This treatment uses two simple radiation beams on each side of the head to target the cancer. It also causes patients to lose the hair on their head. Since hair loss can be upsetting for patients, doctors are experimenting with new types of radiation therapy to see whether they are as effective in treating the cancer while preventing hair loss.

“This new study will encourage doctors to consider using this new radiation technique to treat cancer that has spread to the brain,” said Todd Scarbrough, MD, lead author of the study and a radiation oncologist at the MIMA Cancer Center in Melbourne, Fla. “Although hair loss may seem trivial, losing one’s hair can be difficult for a patient who is already depressed from the diagnosis and the strain of the treatments. I’m hopeful this new study will help us improve the quality of life for these patients.”

In this study, researchers enrolled 10 patients with stage 4 cancer that had spread to the brain. Doctors were able to improve on whole brain radiation therapy by using intensity modulated radiation therapy (IMRT), which allows doctors to further control the intensity of each beam and shape them to better target the cancer while sparing nearby healthy tissue—including hair follicles—allowing patients to significantly reduce the amount of hair lost.

One half of the patients in the study reported only slightly noticeable hair loss four weeks after treatment ended, and one half had no noticeable hair loss. Patients also didn’t experience some of the side effects of whole brain radiation, such as a rash on the scalp or behind the ears. With a short follow-up period, overall survival is 100% and only one patient has seen their cancer progress.

Cancer Patients Hide Their Use of Complementary and Alternative Treatments From Their Doctors
While 48% of cancer patients treated with chemotherapy and radiation use at least one type of complementary and alternative medicine (CAM) treatment, 75% don’t tell their doctor, according to a study presented at ASTRO last month.

“This study shows the significant lack of communication between patients and their doctors about the use of complementary and alternative medicines, like vitamins and herbs,” said Neha Vapiwala, MD, lead author of the study and a radiation oncologist at the University of Pennsylvania in Philadelphia. “It’s important for doctors to know about their patients’ CAM use and to understand patients’ reasons for using them, so that they can better tailor and optimize treatment regimens and improve patient quality of life during radiation and/or chemotherapy.”

The study shows that CAM use is nearly twice as prevalent among patients treated by only chemotherapy (65%), compared with those treated by only radiation (35%). Most (88%) of patients are satisfied with using CAM as a cost-effective method of cancer treatment and use an average of two CAM treatments, with vitamin, herbal, and botanical supplements being the most popular therapies. Only 36% say their doctors were an important source of information on CAM.

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