What are the Alternatives to Traditional Radiation Therapy for Breast Cancer?

By Dana Casciotti, PhD

Women with early-stage breast cancer can safely choose lumpectomy (also called breast conserving surgery) instead of mastectomy if they also undergo radiation treatment to reduce recurrence. However, traditional radiation therapy is given on an outpatient basis 5 days each week for 6-8 weeks, and that is a difficult schedule for many patients.  It can be impossible for those living in rural areas, or who have work or family responsibilities that they can’t leave for such frequent treatments.  Several newer types of radiation treatments have been developed so that more women can have the choice of lumpectomy with radiation.

Several of these newer radiation treatments seem to be safe and effective.  However, research published in December 2011 shows that accelerated partial-breast brachytherapy may not be as safe or effective as traditional radiation treatment.

Accelerated Partial-Breast Brachytherapy vs. Whole-Breast Irradiation

Accelerated partial-breast brachytherapy appeals to many women because it shortens the course of radiation treatment to 1 week.  When the traditional Monday-Friday radiation treatments for 6-8 weeks are the only ones available, some women have little choice but to have a mastectomy, since that does not require radiation.

Accelerated partial-breast brachytherapy consists of the temporary placement of radioactive beads within the breast using a catheter.  The radiation is targeted only to the area of the breast surrounding the lumpectomy.

This newer therapy is much more convenient, but is it safe and effective?

Dr. Benjamin Smith and his colleagues at M.D. Anderson Cancer Center examined the records of over 130,000 early breast cancer patients in the national Medicare claims database.  All patients were treated with lumpectomy followed by radiation therapy between 2000 and 2007.

Less than 1% of these women used partial-breast brachytherapy in 2000, but that increased to 13% in 2007.  When their medical outcomes were compared, women getting partial-breast brachytherapy were significantly more likely to have a mastectomy during a 5-year follow-up period (4% of patients) compared to women who had the regular radiation therapy (2% of patients).

The difference in mastectomy rates could not be explained by age, other health problems, or the presence or absence of cancer in their lymph nodes at the time of initial diagnosis.  The researchers concluded that brachytherapy more than doubled the risk of having a mastectomy in the treated breast within 5 years, compared to standard radiation therapy.

Partial-breast brachytherapy was also more likely to cause wound infection, breast pain, tissue injury, and other noninfectious complications like post-operative bleeding.  Therefore, the new therapy seems more likely to cause patients additional problems after treatment compared to standard radiation therapy. It is assumed that those complications, or a recurrence of cancer in that breast, are the reasons for the mastectomy within 5 years.

The study is not a clinical trial, and clinical trials are considered a more accurate way to evaluate complication risks.  Based on these results so far, standard radiation therapy seems to be safer and more effective than new, partial-breast brachytherapy.

However, we will have more conclusive results when findings are available from a major randomized trial that is part of the National Surgical Breast and Bowel Project.  Unfortunately, those results are not expected for a few more years. 

Dr. Smith’s study results were published online in The Oncology Report on December 7, 2011.

Other Partial Breast Radiation Treatments May be a Better Choice

Brachytherapy is just one type of partial breast radiation treatment being studied.  A research trial called TARGIT-A has had good results treating women with early-stage breast cancer with one dose of partial-breast irradiation given at the time of surgery. This new technology is known as “single-dose targeted intraoperative radiotherapy with Intrabeam.”  A study published in 2010 shows that cancer recurrence and side effects after 4 years were similar in women receiving the new, single-dose treatment compared to standard whole-breast radiation therapy.^[1]

Alternative Full Breast Radiation Treatment

There is also a newer type of radiation therapy given in fewer but larger doses, called hypofractionated radiation therapy.  This therapy, when applied to the full breast over a 3-week treatment period, has been a safe alternative to standard radiation therapy for some women with early-stage breast cancer.^[2]

These positive results, published in 2010, are based on 10 years of follow-up after treatment for women who had undergone breast-conserving surgery for early-stage invasive breast cancer with clear surgical margins and cancer-free axillary lymph nodes.

Doctors and researchers are studying these and other new radiation technology to examine long-term survival and complications.  New radiation treatments may prove to be as safe and effective as standard radiation therapy, or perhaps even better, and there have been some promising results so far.  However, more research is needed before it is possible to conclude whether these treatments reduce recurrence or save lives in the long-term, compared to no radiation or traditional radiation.  Currently, traditional radiation therapy is known to save lives and reduce recurrence for 15 years after treatment,^[3] and we have to wait for future research results to know if other types of radiation are as safe or effective.