October is Breast Cancer Awareness Month, and by now most of us are generally aware of preventative tips such as monthly self-examinations and the importance of regular mammograms. However, most are probably not aware of the advances in breast cancer treatment that are offered and available. Traditionally, treatment included a combination of surgery, radiation therapy and chemotherapy. However, in recent years, we’ve dramatically improved how we deliver these treatments, in particular, radiation therapy. Alison Grann, MD, Chair of Radiation Oncology from Saint Barnabas Medical Center, an RWJBarnabas Health facility, elaborates on new treatment options and new technologies offered for breast cancer patients who require radiation therapy.
RWJBarnabas Health, NJ’s leader in cancer care, together with the Rutgers Cancer Institute of New Jersey, brings a world-class team of researchers and specialists to fight alongside patients, providing close-to-home access to the latest technologies and treatments including clinical trials.
What is Radiation Therapy and What Are the Side Effects?
Radiation therapy is a type of cancer treatment that uses beams of intense energy to destroy cancer cells. Radiation therapy most often gets it power from x-rays, but the power may also come from protons or other types of energy.
“Radiation is one of the most common treatments for cancer and can be given alone or used in combination with other treatments, such as surgery or chemotherapy,” said Dr. Grann. “For many women, radiation therapy is a safe and effective mode of treatment for breast cancer with minimal side effects. It’s similar to getting a chest x-ray. The evolution of the technology allows for pinpoint precision and fewer doses creating improved outcomes and quality of life.”
Because the breast is an external structure, the long-term effects of radiation are minimal. A patient might notice skin changes in the treated area, heaviness in the breast and fatigue, but long-term effects are limited.
How is the need for Radiation Therapy and the type of Radiation Therapy determined for each patient?
“Whether a breast cancer patient needs radiation therapy and the specific type of radiation therapy a patient will receive is decided upon on an individualized basis and depends on a variety of different factors,” said Dr. Grann. These factors include:
- A patient’s age
- The size of the tumor
- Whether the lymph nodes are involved
- Whether the patient has had a mastectomy or lumpectomy
- Specific receptors on the breast cancer itself – such as estrogen and progesterone receptors
In the past, all patients who had a lumpectomy and chemotherapy, also needed approximately six weeks of radiation therapy. However, studies have shown that a more concentrated treatment of radiation therapy delivered in three to four weeks is equally safe and effective.
“Studies and trials have shown us that it is safe to give slightly higher doses of radiation over a shorter period of time to this patient population and that the patients responded well to treatment,” said Dr. Grann. “In fact, cosmetic outcomes are the same and sometimes even slightly better. For those with some certain early stage breast cancers, we’re even having individual conversations on whether they require radiation therapy at all. Either way, we take the time to really look at each case individually and decide who most benefits from radiation treatment.”
Dr. Grann notes that unless the lymph nodes need to be treated, patients who have had a lumpectomy may be offered the shorter course of radiation, regardless of whether or not they’ve had chemotherapy. Although the National Comprehensive Cancer Network recommended treatment guidelines reflect this, only about 20% in the U.S. are offered the shorter courses of radiation.
“At Saint Barnabas Medical Center, we follow best practices and ensure that all patients who are eligible for shorter term radiation are offered that option. As an academic medical center, we are always modifying our treatment practices to reflect the latest research to improve patient outcomes.”
Dr. Grann notes that shorter courses of treatment are not the standard of care for those who have had mastectomies. “The shorter courses of radiation therapy only apply to certain patients who have only had a lumpectomy. Those who have received a mastectomy typically still require the traditional five to six weeks of radiation therapy.”
Advancements in Radiation Therapy Technology
Prone Positioning is where patients lay on a specially designed table on their stomach, with their breast hanging away from the body, which allows localization of radiation to the breast, while minimizing exposure to the surrounding healthy tissue – particularly the heart and lungs. Saint Barnabas Medical Center was the first facility in the state to offer Prone Positioning for breast cancer radiation treatment. “We’ve been doing Prone Positioning for breast cancer treatment for more than 18 years, so we have a lot of expertise in treating patients prone,” said Dr. Grann.
Deep Inspiration Breath Hold (DIBH) is a technique we utilize for some patients to move the heart away from the breast during radiation therapy,” added Dr. Grann. “However, achieving this can be challenging because patients breathe in different ways at different times and may arch their back to simulate a deep breath. These different movements can mimic a deep breath hold, but do not necessarily separate the heart from the breast.” In these cases, physicians at Saint Barnabas Medical Center use motion detecting technology for Surface Guided Radiation Therapy (SGRT). Using three camera units to monitor thousands of points on the patient’s skin, the motion detecting technology will detect movement, with pinpoint accuracy, which will automatically turn off the radiation beam if the patient moves out of position. This protects the patient’s healthy tissues and organs while treating the cancer effectively
When considering how the technology and role of radiation therapy in the breast cancer has changed, Dr. Grann notes how important having a personalized treatment plan is critical.
“We understand that every patient is unique, and our team crafts an effective and individualized breast cancer treatment approach for every person.”
To schedule a mammogram or for more information visit www.rwjbh.org/mammo. Let’s beat breast cancer together.