Thursday, February 18, 2010

Shortened Radiation Treatment for Breast Cancer

An interesting article in the February 11 issue of of the New England Journal of Medicine (full reference below) looking at the effects of shorten regimens of radiation therapy in conjunction with breast conservation surgery in treatment of breast cancer.

Conventional radiation therapy is a 5-week regimen.  It is estimated up to 30% of women who are recommended to receive radiation therapy as part of their treatment for breast cancer may avoid it due to inconvenience and cost.

Researchers have begun to look at using shorter regimens, and are finding that the 10-year recurrence rates and cosmetic outcomes for breast cancer patients are similar.

Dr. Tim Whelan, a professor of oncology of the Michael G. DeGroote School of Medicine at McMaster University, and colleagues compared an intense three-week course of hypofractionated radiation therapy to the standard five-week regimen for women with early-stage breast cancer.

The study included 1234 women with invasive breast cancer who had undergone breast-conserving surgery, had clear resection margins,  and negative axillary lymph nodes.  The women were randomly assigned to receive whole-breast irradiation either at a standard dose of 50.0 Gy in 25 fractions over a period of 35 days (the control group) or at a dose of 42.5 Gy in 16 fractions over a period of 22 days (the hypofractionated-radiation group).

The risk of local recurrence at 10 years was found to be  similar in both groups:   6.7% among the standard irradiation group compared with 6.2% among the hypofractionated group. 

The cosmetic outcome for both groups was found to be similar at 10 years: 71.3% of the control group as compared with 69.8% of the hypofractionated-radiation group had a good or excellent cosmetic outcome.

In the study, there were no cases of grade 4 skin ulceration or soft-tissue necrosis occurred in either group. 

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The most common side effect of radiation therapy for breast cancer needing attention is skin reaction. Most patients develop reddening, dryness and itching of the skin after a few weeks. Some patients develop substantial irritation.

Some patients develop a sunburn-like reaction with blistering and peeling of the skin, called "moist desquamation,"  most often in the fold under the breast or in the fold between the breast and the arm.   Most people with a limited area of moist desquamation can continue treatment without interruption.  Skin reactions usually heal completely within a few weeks of completing radiotherapy

Skin care recommendations include:

  • Keeping the skin clean and dry using warm water and gentle soap
  • Avoiding extreme temperatures while bathing
  • Avoiding trauma to the skin and sun exposure (use a sunscreen with at least SPF 30)
  • Avoiding shaving the treatment area with a razor blade (use an electric razor if necessary)
  • Avoiding use of perfumes, cosmetics, after-shave or deodorants in the treatment area (use cornstarch with or without baking soda in place of deodorants)
  • Using only recommended unscented creams or lotions after daily treatment.

 

 

Source reference:
Whelan TJ, et al "Long-term results of hypofractionated radiation therapy for breast cancer" N Engl J Med 2010; 362: 513-20.

American Cancer Society

Radiology Info

4 comments:

Jungkyu said...

Great blog and how warmful blogger you are. Hi I'm a 28-year-old resident in South Korea. I am in my first year and I must do another three years to become a real plastic surgeon. Actually I just saw a women with extensor tendon injury at ER and this blog is really nice to study with. (It's definitely easy to understand than textbook.) I added it to my favorites and I hope to visit this blog frequently. Thanks again for being my wonderful teacher.

rlbates said...

Jungkyu, thank you for your kind comment. Best wishes to you.

Gizabeth Shyder said...

This is what we talked about in breast conference this week!

rlbates said...

Gizabeth, wish I had remember the conference. I could have attended this one.