Whole breast radiation and partial breast radiation following a lumpectomy yield similar cosmetic outcomes for women diagnosed with early stages of cancer who wish to preserve their breasts. Findings of the new analysis from a phase III clinical trial will be presented today at the 61st Annual Meeting of the American Society for Radiation Oncology (ASTRO) in Chicago.
“Partial breast radiation is a good choice. That’s what I’m going to say to certain subsets of my patients,” said Julia White, MD, FASTRO, a professor of radiation oncology at The Ohio State University Comprehensive Cancer Center and lead author on the abstract.
Women diagnosed with early stages of cancer (stage 2 or earlier) who undergo lumpectomies typically follow their surgery with radiation therapy to lower the risk of having the cancer return. Partial breast radiation can be an appealing treatment option, because the radiation is delivered over several days to a smaller area around the surgical site instead of 3 to 4 weeks to the entire breast.
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Previously published results from this phase III trial, NRG Oncology/NSABP B39-RTOG 0413, found partial breast radiation to be only slightly less effective than whole breast radiation at reducing the risk of cancer recurring in the breast. There were no significant differences between treatment groups in overall survival rates, the time patients lived without the cancer coming back, or the time patients lived without the cancer spreading to another site. In the current analysis, Dr. White and her team focused on cosmetic outcomes to help guide patients for whom both treatment choices would be equally or nearly equally effective for breast-conserving therapy.
In this analysis of 900 women with early stage breast cancer who received either partial breast radiation (n=477) or whole breast radiation (n=423), both the patients and their physicians were asked to rate the cosmetic outcome of the treated breast, in comparison to the untreated side, as either excellent, good, fair or poor at three different times (baseline, 12 months after treatment and three years after treatment). Patients also rated their satisfaction with the outcome. Additionally, digital photos of the women’s breasts acquired at each time point were rated by two teams of three physicians each who were blinded to which treatment the women received, when the photos were taken or which breast was treated.
“We found that whether the women received whole breast radiation or partial breast radiation, there was an equivalent cosmetic outcome from the patients' perspective,” said Dr. White. This pattern held whether the patient also received chemotherapy as well as radiation and lumpectomy. In addition, patients' satisfaction with their treatment and cosmetic outcome were equivalent for whole breast and partial breast radiation. Three years after completing radiation therapy, 81% and 86% of patients said they were totally satisfied with partial breast or whole breast radiation, respectively; 14% and 11% were somewhat satisfied; 2% and 3% were neither satisfied nor dissatisfied; 1% and 2% were somewhat dissatisfied; and less than 1% of patients in each group said they were totally dissatisfied with their treatment.