Study Confirms Effectiveness of High-Dose Radiation in Shorter Time

IMRT (intensity-modulated radiation therapy) is a highly sophisticated system of delivering external-beam radiation.

As technology advances, cancer treatment decisions become more complicated. And while physicians will advise, you decide what treatment is right for you.

Lisa Warren, of Doylestown, Pa., realized she had a big decision about treatment after having a lumpectomy for breast cancer in 2004. After undergoing four rounds of chemotherapy, radiation oncologist, Gary Freedman, MD, introduced Warren to a study investigating the effectiveness of high daily doses of radiation therapy administered in four weeks as opposed to the traditional six. Following discussions with her family and physicians, she decided to enroll in the study.

Because of Warren and 74 other women who participated in the study, physicians at Fox Chase demonstrated that treatment time can be shortened from six to four weeks using IMRT (intensity-modulated radiation therapy). This highly sophisticated system of delivering external-beam radiation allows for more even dose distribution and accuracy as well as lower doses to organs such as the lungs and heart, thus reducing side effects.

"To me, it was just as good [as the lower dose], if not more advanced," Warren says. "I felt it would be in my best interest health-wise with the better technology that delivered the higher dose of radiation directly to the tumor. It was all around the best scenario."

During the four-week period, the lumpectomy site where the tumor was removed was treated with a high-dose radiation "boost." The standard "boost" is typically administered after four to five weeks of whole-breast irradiation and adds another one to two weeks to the treatment time.

Freedman and his colleagues demonstrated that in addition to safely increasing the dose to the whole breast during the four-week period, it is possible to deliver the "boost" concurrently, eliminating the extra two weeks.

"Acute toxicity on this clinical trial is not only acceptable but also compares favorably with the results seen for conventional standard fractionated radiation therapy," Freedman says.

The study also examined side effects or cosmetic outcomes that may result from the more intense treatment, but fortunately most women did not experience adverse effects.

"Dr. Freedman told me that with higher radiation, there would be a greater chance of skin rash, but I had none of this," Warren says. "In fact, there was very little change. Cosmetics were the least of my worries, but it was great to have that result."

Monica Morrow, MD, chair of surgical oncology at Fox Chase and a co-author of the study, is an expert in patient-decision making. "Many women with breast cancer are working, have families, volunteer or have other commitments," she points out. "When they consider whether to have a lumpectomy or mastectomy, the time commitment of treatment and recovery carries significant weight.

"Women may prefer a lumpectomy but often choose a mastectomy to avoid the time needed for the radiation. We believe this research is a big step in reducing the barriers for choosing breast-conserving surgery."

Warren was pleased to have been part of the study, saying, "I felt this would help me and many other people to make a decision regarding treatment."