1. As reported by the American Cancer Society, some elderly women with early-stage breast cancer may be able to safely skip radiation treatments, a new study suggests. The researchers came to this conclusion after comparing two groups of elderly women treated for small cancers. One group was given tamoxifen after undergoing lumpectomy, while the other got tamoxifen and radiation. The finding reported in the New England Journal of Medicine, means some women may be able to avoid the time and expense of radiation treatment, as well as possible side effects such as breast and arm swelling, breast pain, and poorer cosmetic results.

Even though giving radiation after a lumpectomy can delay a relapse of breast cancer, it does not seem to improve overall survival. Radiation therapy still has the potential to damage the heart, even though modern techniques have made the treatments safer than ever. In some clinical studies, women who had radiation in addition to tamoxifen reported worse breast pain, swelling, and cosmetic outcomes in the first few years of follow-up compared to women who took only tamoxifen. After about 4 years, though, these effects were about the same in both groups.

Kevin Hughes, M.D., the lead study author feels that if a patient does not need to have radiation therapy, their quality of life can improve significantly. The researchers noted that women who received radiation therapy in addition to Tamoxifen were less likely to have their cancer return in the same breast or nearby tissue. However, elderly women already have a low risk of recurrence because their breast cancers tend to be less aggressive at that age, without the added toxicity profiles of radiation.

And elderly women also are more prone to have other illnesses that are more likely to be deadly before breast cancer would be. It may be possible to reduce the risk of relapse even further by adding aromatase inhibitors to treatment. Studies of younger women have shown that these newer drugs can lower the risk of breast cancer recurrence even more when given after a course of tamoxifen.

Dr. Hughes has pointed out that the local recurrence risk in both groups of their study was extremely low and women who have not had radiation have the option of another lumpectomy if they do have a recurrence in the same breast. Once a patient has had radiation, they must have a mastectomy if the tumor recurs. Every woman and her physician should choose a treatment plan by weighing the risk of a slight increase of local recurrence verses the patient's time, adverse effects and financial cost.

A lot of studies push many physicians and scientists toward the goal of finding the tiniest improvements in treatment rather than genuine breakthoughs, that rewards academic achievement and publication even though their proven activity has little to do with "curing" cancer. It falls short of meeting the toughest standard for improving overall survival.

New England Journal of Medicine (Vol. 351, No.10: 971-977)

Posted at 6:15PM on Jan 23rd 2007 by Gregory D. Pawelski

2. The study showed:
In a records-based analysis of outcomes of than 1,800 patients, the investigators also found that breast-conserving surgery without radiation was associated with a 3.5-fold (350%)risk for local or regional recurrence of primary breast cancer,

Women had a benefit from adjuvant radiation regardless of their age, co-morbidities, or the use of tamoxifen (among those with hormone-sensitive tumors), the authors noted.

"We recommend that mastectomy or breast-conserving surgery with radiation therapy, along with adequate duration of adjuvant hormone therapy for patients with hormone-responsive tumors, be considered standard therapy in women of all ages and with all co-morbidity burdens, except for women with very limited life expectancies," the investigators wrote.

The above commenter misses the point:

"Older women's risk of dying from tiny breast tumors is extremely low, so a survival benefit from radiation is unlikely, says breast cancer surgeon Kevin Hughes of Massachusetts General Hospital."

Cut the risk of recurrence by 350% and, thus later treatment?

Women will choose that.

Posted at 8:54AM on Jan 24th 2007 by hchcec

3. All 636 elderly women in the Hughes' study had small tumors (no larger than 2 cm) that were removed by a breast-conserving surgery, and all were given 5 years of tamoxifen therapy afterward. But about half of the women (317) were also given radiation therapy.

Women who received radiation therapy in addition to tamoxifen were less likely to have their cancer return in the same breast or nearby tissue. Just 2 women in that group (1%) saw their cancer return locally, while 16 women who received only tamoxifen (4%) had a local relapse in that period, statistically insignificant in the real world.

The local recurrence risk in both groups was extremely low, and women who have not had radiation have the option of another lumpectomy if they do have recurrence in the same breast. Once a patient has had radiation, they must have a mastectomy if the tumor recurs.

Rates of mastectomy because of a subsequent recurrence were 1% in the group that received radiation, and 2% in the tamoxifen-only group -- a statistical dead-heat. Rates of distant spread were also the same: 7 women in each group saw their cancer return in another part of their body. There was no difference in survival, either: 3 women in each group died of breast cancer, and about equal numbers died from other causes.

This study finds that giving radiation after lumpectomy can possibly delay a relapse of breast cancer, but in the elderly, it does not seem to improve overall survival.

Posted at 6:04PM on Jan 24th 2007 by Gregory D. Pawelski

4. For some, like older women with very small tumors, the risk of dying is very low and so radiation may not be a priority. For other older women, like those in their 80s, the hassle and discomfort of a six-week course of radiation might not be worth it. BUT, for those on the fence about whether or not to sign up for radiation treatment, it seems submitting to the treatment definitely has its merits, a 350% reduction in recurrence.

Posted at 4:50PM on Jan 24th 2007 by hchcec

5. MammoSite is a form of localized radiation that treats only the area of the breast immediately around the site of the tumor. Traditional radiation treats the entire breast in which the tumor was located. And MammoSite reduces the duration of radiation treatments from six weeks to just five days, a trend to scale down the scope of treatments for breast cancer.

During the MammoSite treatment, a small balloon with a thin catheter attached to it is placed into the cavity where the tumor had been removed. As the patient lies on a table in a sealed room, a radioactive seed is administered by machine through the catheter into the balloon. The seed remains in the balloon for about seven minutes, at which time it's automatically removed. The patient undergoes therapy twice a day, at intervals at least six hours apart, for five days.

The patient then takes Tamoxifen, a drug that blocks the effects of estrogen on the body, to treat tumors that are sensitive to estrogen. This less intensive treatment usually results in fewer side effects and can be just as effective as more aggressive treatment. It is an option for early breast cancer patients while a solitary tumor is small, and has not spread to the lumph nodes. The advantages are that radiation treatment is concentrated to the local tumor bed.

For many decades, hormonally responsive breast cancer has been managed by use of sequential hormone therapies: oopherectomy, adrenalectomy, diethylstilbesterol, testosterone, progesterone, tamoxifen, aminoglutethimide, and now arimidex.

Armidex may be more effective than tamoxifen in preventing recurrence, but it's unclear whether or not treatment with arimidex following recurrence on tamoxifen will not have a "salvage" effect. The recurrence-free data with arimidex are pretty impressive, however, the osteoporosis and fractures are obviously a problem.

http://www.mammosite.com/Mammosite.htm

Posted at 6:45PM on Jan 25th 2007 by Gregory D. Pawelski