30 Oct Breast Ca: Boosts

     Well this week is the official American Society for Therapeutic Radiology and Oncology meeting in Los Angeles, CA. It is always a wonderful meeting with a lot of good information for other oncologists (cancer doctors) and other cancer care professionals. This is typically where a lot of studies will be reported on, results from clinical trials, new methods, new techniques, and where new and exciting treatments are unveiled and shared with everyone in attendance. It is a wonderful place full of knowledge and cutting edge techniques all surrounding the treatment of cancer.
In a report released on-line by ABC medical news unit, reported by Katharine Stoel Gammon (full report) they talk about a study that was released on the 29th of October by Dr. Harry Bartelink from the Netherlands Cancer Institute in Amsterdam. This study takes a look at the 10 year data for women with breast cancer that receive a “boost” to the cancer bed at the end of their typical radiation therapy treatments.
What the study found was that women that received this additional “boost” to the original site of the breast cancer are almost 2x more likely to be cancer free after 10 years then women that did not receive the additional boost. This seemed to have the strongest survival benefit in women under the age of 40, yet all women seemed to have a benefit from the additional radiation “boost.”
Dr. Bartelink stated that he was very pleased with the results of the study. He said that more then 80% of women were alive after 10 years. He also stated that even though only 5% of all breast cases involve women under the age of 40, that it is still very beneficial since this subgroup of women also tend to have the highest rate of recurrences. This is due to the fact that women under the age of 40, have a lot more years to live, allowing the potential for the cancer to come back over that amount of time.
                                       
Treating early stage breast cancer typically involves a lumpectomy (removal of the breast cancer itself from the breast) followed by a course of radiation therapy. This course of treatment typically take 6 to 8 weeks of time. Patients receive radiation 5 days a week. The entire breast is at risk for a recurrence, so the radiation treatments involve the entire breast tissue during this time.  
The one thing to consider, is that the data also states that if a women is going to have a recurrence, 90% of the time that recurrence is going to happen at the same site of where the original breast lesion was discovered. Due to this fact, the entire breast will need a lower dose of radiation as compared to the lumpectomy site itself. This “boost” allows the lumpectomy site to get a higher dose of radiation with minimal additional side effects.
The biggest side effect in this small additional dose is fibrosis (scar tissue) at the lumpectomy site. The standard average seen is about 1%, with the additional “boost” it may rise to about 4%. This can be decreased back to the 1% with better surgical techniques. The other side effects that some patients may experience with this additional boost are redness, a slight swelling, and perhaps a bit more tenderness.
                 
The one good thing for all of us to remember, is that in the US, in the vast majority of cancer centers, that this additional “boost” has been the standard of care for many years. So this means that most women that have received radiation for their breast cancer have already received an additional boost to the original breast cancer site. The “boost” to the lumpectomy site is also performed with electrons, which is a much lower energy, and does not penetrate as deeply as the radiation to the entire breast. This allows for the dose to be aimed more precisely at just the lumpectomy site and sparing more of the normal tissues. As you can see in the above picture, the circled area on the breast with the blue in the top image is the area that will be treated with the “boost.” In the lower picture, the area that is highlighted in pink is the lumpectomy cavity that will receive the additional “boost.”
                              If you question if you received this additional boost, try to remember your breast cancer treatment. You most likely received the majority of your treatment from the machine being in two different spots. If you received the additional boost treatment, it would most likely been at the end of your treatment, the last 5 days, and the machine would have only been in one spot.  The therapists would have placed a “cone” onto the machine, and this would direct the boost to the lumpectomy site. You would also notice that the machine was really close to you as well. The machine would have looked and been positioned much like the picture above.

As always, if you or a loved one have any other questions, comments, or concerns; if you would like more information in regards to another cancer related topic, please contact me at: CANCERGEEK@GMAIL.COM or CANCERGEEK@CANCERGEEK.COM

~CancerGeek