Positive Energy: Preventing Local Recurrence of Breast Cancer With Radiation

Radiation therapy after surgery can help prevent the local recurrence of breast cancer, and new methods are allowing doctors to tailor the technique to meet the needs of individual patients.
Leslie Husain knows a thing or two about radiation.

The 52-year-old wife and mother of two spent years working as a radiology technologist, performing mammograms on countless women. Four years ago, after having her own routine mammogram at the very hospital at which she used to work, she got some unexpected news — there was something in her left breast. An ultrasound soon confirmed it: Husain had a tumor that measured about 8 millimeters, right below her nipple.

A few weeks later, on July 8, 2011, Husain underwent a lumpectomy. During the surgery, she says, doctors were able to confirm through a tracer procedure — which identifies lymph nodes that drain from the affected area of the breast — that her sentinel node was clear (meaning the cancer had a very low chance of spreading to other lymph nodes). That was welcome news, since it meant she did not need to undergo an axillary dissection, more extensive surgery that carries a higher risk of lymphedema, permanent swelling of the arm.

Because her tumor was small and found early, and because her cancer was confined to the breast, Husain did not need to undergo chemotherapy, drugs that are typically given through the bloodstream to treat invasive cancers or cancers that have advanced into other areas of the body. Husain says that only 3 millimeters of her tumor was invasive, with ductal carcinoma in situ (DCIS), or stage 0 cancer, surrounding the invasive part.

Her doctors determined that radiation therapy was appropriate to help prevent a recurrence in the breast and, together, they began to talk about options.

“My radiation oncologist told me about a Canadian study of the hypofractionated approach,” she says. Hypofractionation (sometimes called accelerated breast irradiation) treats patients with a slightly larger dose of daily radiation over a shorter duration of time. “Cutting the treatment time down from six weeks to four sounded good to me,” Husain says.

But after her first surgery, doctors realized she still had one microscopic spot of DCIS on one “little spot of margin,” she says. Her radiation oncologist wanted the margins clear before radiation therapy began, so she had a re-excision surgery on July 20. In August 2011, Husain began her hypofractionated radiation treatments — just after dropping her daughter off to begin her junior year of college, and as her son began his freshman year — and finished them three to four weeks later. Today, because her tumor was estrogen receptor-positive, she continues to take tamoxifen, a hormonal therapy designed to block the effects of estrogen and reduce the risk of cancer recurrence.

“Almost all patients who have local surgery [lumpectomy] benefit from having radiation,” says Jaroslaw T. Hepel, director of the stereotactic radiotherapy and radiosurgery program at Rhode Island Hospital and assistant professor of radiation oncology at the Warren Alpert Medical School of Brown University. When a lumpectomy is performed, he explains, microscopic cancer cells can be left behind. Radiation reduces the chance of local recurrence of the cancer by destroying those microscopic cells.

Catherine Park, chair of the Department of Radiation Oncology at the University of California San Francisco and professor in residence in radiation oncology, says that, after surgery, radiation has a larger impact than systemic therapies do in reducing the local recurrence of cancer.

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