Q: Are there any new clinical studies or treatments for Stage 1 Invasive Ductal Breast Cancer? I was just given this diagnosis and am searching for something other than lumpectomy followed by balloon radiation.
There are several treatment options for Stage I ductal carcinoma of the breast. Which particular option is available to you depends on certain factors – your age, tumor size and other characteristics, your breast size and shape, and your personal goals of treatment. I’ve provided some general information below, but any specific treatment options should be discussed with your doctor.
First, it’s important to decide if you want to preserve your breast and have a lumpectomy (also called a partial mastectomy). The tradeoff for keeping the breast is receiving radiation treatment in some form. Previously, the only radiation choice was six and a half weeks of daily radiation to the entire breast. Fortunately, over the past few years, several other options have become available, including:
• Hypofractionation – For many women requiring whole breast radiation, delivering a higher dose of radiation per day can shorten treatment time to about three weeks. This technique has been shown to have the same rates of control of the breast cancer without sacrificing the cosmetic outcome.
• Partial breast radiation – Radiation is given only to the area of the breast where the tumor is located, thereby sparing the remainder of the breast from radiation. In women over age 60, or between 50 and 60 with “good” prognostic features of the cancer, partial breast radiation may be considered. These partial breast radiation techniques carry a slightly higher risk of cancer returning in the breast in women younger than 50. In those cases the patient must be carefully selected and appropriately counseled.
o “Balloon” radiation is one of these techniques. It involves placing a special device in the lumpectomy site through which radiation catheters are passed twice a day for five days (ten total treatments) over a period of a few minutes, delivering radiation only around the balloon. The device is removed after the last treatment without need to return to the operating room. In some cases, the shape of the breast or closeness of the tumor to the skin prevents use of this technique.
o External beam radiation –Conventional external beam radiation, as is used for whole breast radiation, may be more precisely aimed to radiate only the breast tissue around the lumpectomy site, delivering radiation treatment twice a day for five days.
o Intraoperative radiotherapy (IORT) – This technique delivers the radiation treatment in the operating room at the time of the lumpectomy. During surgery, right after the lumpectomy is completed, a concentrated dose of radiation is delivered directly to the breast tissue adjacent to the lumpectomy site. During this procedure, the skin is kept away from the radiation source, and the structures deep to the breast such as the chest wall, ribs, lung, and heart, are protected. Once this single dose of radiation treatment is delivered, the breast is then reshaped and the skin is closed. At Cancer Treatment Centers of America® in Philadelphia, we’ve been using IORT for four years with excellent results in controlling the cancer and good cosmetic results. While this is not the correct choice for everyone, it can allow many women an option to preserve the breast and have all the necessary surgical and radiation treatment at one time, significantly shortening the length of overall treatment.
Another option is to undergo a total mastectomy, which is removing the entire breast. This often can be followed by immediate reconstruction by a plastic and reconstructive surgeon. For Stage I cancer patients, radiation is generally not needed if the entire breast is removed. Reconstruction techniques vary and can include implants or using a woman’s own tissues. The plastic and reconstructive surgeon will help a woman make the most appropriate choice for her.
No matter what you decide to do, it is important that your doctor helps you understand all of your options to help you choose the right treatment choice for your circumstance. Every woman, and every cancer, is different, and the treatment should be tailored that way.