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A Better Way to Beat Breast Cancer

With Dr. Frank Vicini, MD

A diagnosis of breast cancer can be devastating to any woman; unfortunately the treatment and its aftermath can be just as devastating. That story could all be changing with research that is being done around the country and being led by a team right here in the Detroit area. Dr. Frank Vicini and the oncologists and surgeons at Beaumont Hospital have been leading a study into Accelerated Partial Breast Irradiation (APBI) therapy. While this procedure has been utilized around the world since 1992, it was only in 2005, that a randomized, multi-center study was launched under the auspices of the National Cancer Institute and National Surgical Adjuvant Breast and Bowel Project. The study is looking at women with early-stage breast cancer who have a lumpectomy followed by radiation therapy. Originally envisioned to be a study involving 3000 women, it has recently been expanded to 4300. The women are randomized to have either the standard regimen of six and a half weeks of full breast irradiation therapy or partial-breast irradiation therapy twice a day for five days. The study is expected to be completed by 2009.

What does this mean for women with early-stage breast cancer? In the past, women often had to struggle to fit their radiation therapy into their lives since it is every day, Monday through Friday for almost two months. Women who live far away from their treatment centers or who are older and have trouble transporting themselves to their treatment center have often had to choose to have mastectomy rather than the breast-saving lumpectomy procedure. They may also choose to have a lumpectomy without the following radiation therapy which could allow the cancer to return. By being able to shorten the course of radiation therapy to five days, more women may be able to have the lumpectomy with radiation therapy and therefore have the best chance of staying cancer-free. Hopefully the study will also show that the shorter duration therapy is associated with fewer side effects. Preliminary research has shown that partial breast radiation over five days works as well as whole breast radiation for cancer control but these studies involved a smaller number of women. This new study will help to make the five day regimen the standard of care for early-stage breast cancer.

“The medical community has known for some time that radiation administered to the entire breast has its primary effect at or near where the tumor was,” says Dr. Vicini, a radiation oncologist at William Beaumont Hospital in Royal Oak and the principal investigator for the study. “That is what leads us to believe that it may not be necessary to treat the whole breast in certain patients.” Radiation damages the cancer cells and since they are unable to repair the damage, they die and are removed by the body. Healthy tissue that is irradiated is able to repair itself.

Current standard of care for early-stage breast cancer involves either a mastectomy to remove the entire breast which has the cancer, or a lumpectomy with whole breast irradiation plus possible chemotherapy. Whole breast irradiation can have some serious side effects for the healthy breast tissue as well as adjacent organs and tissues. Under this new regimen, patients would undergo a lumpectomy followed by partial breast irradiation plus possible chemotherapy. The partial irradiation is administered one of two ways. The most common form of partial breast irradiation is called breast brachytherapy and involves using a catheter to insert a small balloon into the cavity where the cancer was located. For each session, the balloon is connected to a brachytherapy machine which directs a small radioactive seed into the balloon and is left in place for ten minutes. This irradiates only the tissue surrounding where the cancer was removed and has the greatest likelihood of still containing any remaining cancer cells. Another form of partial breast irradiation is called 3-Dimensional Conformal Partial Breast Radiotherapy and delivers very precise doses of radiation to specific areas of the breast, sparing surrounding normal tissue. The shorter course of treatment is made possible not only by specifically targeting the lumpectomy site, but by also increasing the radiation levels for each treatment. While each treatment involves more radiation, the partial breast procedures involve less overall radiation exposure.

While there still is no cure for breast cancer, advances are being made in its treatment right here in your backyard. With early detection and treatment over 80 percent of breast cancer patients are cancer free ten years after their diagnosis. If you are interested in participating in this study, contact Beaumont Hospital at 248-551-7695.

Dr. Frank Vicini is the Corporate Chief, Oncology, at Beaumont Hospitals and is board certified by the American Board of Radiation –Radiation Oncology. He is a graduate of Wayne State University and completed his residency in Radiation Oncology at Beaumont hospital followed by a fellowship at Harvard University Medical School. He has been in practice 22 years.