05:24pm Tuesday 19 November 2019

Long Term AGH Clinical Trial Endorses Less Invasive Therapy When Breast Cancer Recurs

Paper one of nine presentations by West Penn Allegheny researchers at national meeting
PITTSBURGH/Miami  – Treating a breast cancer recurrence with a combination of radioactive seed implantation and tumor excision rather than with mastectomy, or whole breast removal, is an effective approach for many women, according to a long-term study presented today at the  annual meeting the American Society for Therapeutic Radiology and Oncology (ASTRO) by cancer specialists at Allegheny General Hospital (AGH) in Pittsburgh.
The study is one of nine presentations by AGH/West Penn Allegheny Health System physicians and researchers at the ASTRO conference in Miami Beach, FL.  Founded in 1958, ASTRO is the largest radiation oncology society in the world with more than 10,000 members committed to advancing the scientific base of radiation therapy and extending the benefits of radiation therapy to patients with cancer and other diseases.
“Our findings add to a growing body of knowledge suggesting that mastectomy can sometimes be avoided when treating women with a breast cancer recurrence,” said lead author Mark Trombetta, MD, System Director of Clinical Program Development, Department of Radiation Oncology for West Penn Allegheny Health System (WPAHS). “Mastectomy can be a disfiguring procedure that poses emotional and psychological challenges for women. The ability to further minimize the need for it through equally effective, less invasive adjuvant therapies is another step forward in the fight aainst this disease.”
In the AGH study, twenty-two women with recurrent tumors were offered tumor excision followed by low-dose radiation delivered via seed implants (brachytherapy) as an alternative to mastectomy. Researchers followed them from 17 months to 9 ½ years (average 5 ½ years). During that time, the tumor recurred in only one woman, and she was subsequently successfully treated with mastectomy. Long-term cosmetic results were also acceptable as defined by the Harvard Cosmesis Scale and a modification designed by doctors at AGH. A second woman saw a recurrence in the opposite breast, and three others died of systemic disease.
“These long-term results show that lumpectomy followed by brachytherapy is a feasible alternative,” Dr. Trombetta said. “We look forward to seeing the results of the Radiation Therapy Oncology Group’s Phase II clinical trial of repeat breast-conserving surgery and re-irradiation, which should help further define the role of repeat conservation therapy.”
Co-authors of the paper are Thomas Julian, MD, Director, Division of Breast Surgical Oncology, WPAHS; Yongbok Kim, Ph.D., Senior Medical Physicist; E. Day Werts, Ph.D., Director of Education and Clinical Research, AGH Radiation Oncology; and David Parda, MD, Chairman, Department of Radiation Oncology, WPAHS.
Other AGH/WPAHS research from the Department of Radiation Oncology set for presentation at the ASTRO meeting includes:
          Athanasios Colonias, MD, reports on the impact of using an imaging technique developed at AGH that allows him to confirm that lung tumors being treated are captured within the treatment field. This is important as motion during breathing can move the tumor out of the radiation field.
          Matthew Packard, MD, and Russell Fuhrer, MD, Director of Clinical Operations, reviewed rectal bleeding complications in prostate cancer patients receiving external beam radiation along with a radioactive seed implant. They concluded that the size of the area receiving radiation must be carefully controlled, as bleeding complications increase along with the treatment area.
          Yongbok Kim, Ph.D., working with Dr. Trombetta, compared two new balloon catheters used for partial breast irradiation following lumpectomy and found they both deliver similar radiation doses.
          Brian Leicher, CMD, Senior Medical Dosimetrist, AGH Department of Radiation Oncology, studied a new technique that reduces the amount of tissue involved in radiation delivery without altering the prescribed dose. Application of this technique could result in reduced damage to normal tissue during treatment.
          Ellen Day, Ph.D, Senior Medical Physicist;  Dr. Colonias and Olivier Gayou, Ph.D., Director of Medical Physics Research, also reported on a technique to evaluate motion in lung cancer patients while they are receiving radiation treatment, part of the researchers’ ongoing work toward reducing the volume of normal tissue included in the radiation field. They found that patient movement can be significant and that different techniques may be required to either restrain the patient or track motion.
          Dr. Gayou, along with Dr. Fuhrer and AGH Radiation Oncologist Stephen Karlovits, MD, assessed a technique that could be used to allow brain cancer patients to be treated without an immobilizing frame attached to their heads. Motion management and positioning are critical to avoid irradiating normal tissue.

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