“Adjuvant radiation therapy (RT) after lumpectomy for elderly women with early stage triple negative breast cancer (TNBC) improved overall survival (OS) and disease specific survival (DSS), a retrospective analysis of cases from the Surveillance, Epidemiology, and End Result (SEER) database has shown.
“The review showed that adjuvant radiation was associated with an overall six-fold decrease in any death, as well as death from breast cancer, Sean Szeja, MD, of The University of Texas Medical Branch at Galveston, and colleagues reported in a poster session at the American Society of Clinical Oncology (ASCO) Breast Cancer Symposium (Sept. 25-27).
“Some 23 months after diagnosis, 98.2% of women who received lumpectomy and radiation were alive, compared with 85.6% of those who received lumpectomy alone, the investigators said. In addition, the analysis revealed that breast cancer-related deaths were more common in the lumpectomy only group (6%) compared with the lumpectomy and radiation group (1%).”
“Breast-cancer specialists are sharply divided over a new radiation technique that costs less and is more convenient than conventional therapy.
“The technique, known as intraoperative radiation therapy, or IORT, involves administering a single dose of radiation at the same time a patient is having lumpectomy surgery to remove a tumor. A large, randomized controlled trial concluded that IORT has fewer side effects and appears to prevent the return of cancer nearly as well as traditional treatment, in which patients undergo radiation sessions five days a week for up to seven weeks.
“Oncologists with opposing opinions have been debating that conclusion in letters and editorials in major medical journals, including the Lancet and BMJ. Some critics point out that the study found women who had IORT face twice the risk of a cancer recurrence compared with traditional radiation (3.3% versus 1.3% over five years).”
“Women who receive a shorter course of whole breast radiation therapy for early stage disease experience less toxicity and improved quality of life compared to those who undergo a longer course of treatment, researchers report from The University of Texas MD Anderson Cancer Center.
“Published in JAMA Oncology, the authors believe these findings should be communicated to women as part of the shared decision-making between breast cancer patients and their physician.
“Historically in the management of breast cancer in the U.S., radiation treatment has been given in smaller doses over a longer period of time, in a method called conventionally fractionated whole breast irradiation (CF-WBI), rather than with higher doses over a shorter period of time, or hypofractionated whole breast irradiation (HF-WBI).”
“Two new studies show promising results for the use of radiation therapy to prevent breast cancer from coming back.
“The research shows that when patients with breast cancer received radiation therapy to their lymph nodes – not just the area of the breast where cancer occurred – cancer did not recur in the original site or spread to other parts of the body. Interestingly, the results were the same regardless of whether the cancer had spread to the lymph nodes.
“A group of Canadian researchers at the Juravinski Cancer Center at Hamilton Health Sciences led a study of more than 1,800 women. In a separate project, researchers at Radboud University Medical Center in the Netherlands studied more than 4,000 European women. Results were published online Wednesday in the New England Journal of Medicine.
“All of the participants had undergone a lumpectomy or a mastectomy. The studies then compared recurrence and survival data between a group of women who received radiation to their lymph nodes against those who did not.”
“Increased radiation dose is associated with higher survival rates in men with medium- and high-risk prostate cancer, but not men with low-risk prostate cancer, according to a new study from Penn Medicine published this week in JAMA Oncology. Already-high survival rates for men with low-risk prostate cancer were unaffected by higher radiation dosages compared to lower radiation dosages.
“In 2014, low-risk prostate cancer was the most common type of prostate cancer diagnosed in the United States, affecting about 150,000 patients, many of whom undergo aggressive treatment, either complete removal of the prostate or radiation.
“ ‘Our study raises the provocative question of whether radiation dose reduction for patients with low-risk prostate cancer could achieve similar cure rates while avoiding the increased risk of side effects associated with higher radiation doses,’ said the study’s lead author, Anusha Kalbasi, MD, a resident in the department of Radiation Oncology at the Perelman School of Medicine at the University of Pennsylvania.”
“More U.S. physicians are sparing their low-risk prostate cancer patients from surgery, radiation and hormone therapy in favor of monitoring their patients over time — a strategy called watchful waiting, a new study shows.
“The number of low-risk patients who didn’t undergo treatment jumped from as low as 7 percent from 1990-2009 to 40 percent from 2010-2013, the study revealed. These findings indicate that more patients are being monitored to see if their conditions get worse.
“This is ‘excellent news’ about the popularity of ‘active surveillance,’ said study author Dr. Matthew Cooperberg, the Helen Diller Family Chair in Urology at the University of California, San Francisco.
” ‘We expected to see a rise in surveillance rates, but were surprised by the steepness of the trajectory,’ he said. ‘This really does represent a paradigm change, and it’s faster than the typical pace of medical evolution.’ “
“The retrospective analysis, one of the largest cohorts in which contemporary CIEDs were exposed to photon- and electron-based radiotherapy, demonstrated that more than 10 MV of neutron-producing radiotherapy resulted in a device compromise rate of 21%.
“In 178 courses of non-neutron-producing radiotherapy, however, the device compromise rate was 0%, Jonathan D. Grant, MD, department of radiation oncology, University of Texas MD Anderson Cancer Center, Houston, and colleagues said in an online report in JAMA Oncology.
“Single-event upsets also occurred during neutron-producing radiotherapy at a rate of 10% in pacemakers and 34% in implantable cardioverter-defibrillators per course, Grant said.
“Based on these findings, the investigators recommend that non-neutron-producing radiotherapy be used whenever possible. In cases where higher radiotherapy energies are of clinical benefit, however, they emphasized that ‘error rates and outcomes that we report will aid clinicians in weighing the risks of using neutron-producing radiotherapy.’ “
“A week-long course of accelerated partial breast irradiation (APBI) after lumpectomy led to low rates of breast cancer recurrence and a 10-year survival of 96%, investigators in a multi-institutional study reported.
“Patients treated with the interstitial brachytherapy protocol had a 10-year actuarial risk of ipsilateral recurrence of 7.6%, regional failure rate of 2.3%, and distant metastasis rate of 3.8%. High-grade disease at diagnosis and positive surgical margins were the only significant predictors of an increased risk of local recurrence.
“The results compare favorably with those associated with whole-breast irradiation that requires 6 or 7 weeks to complete, Mitchell Kamrava, MD, of the University of California Los Angeles, and co-authors indicated in an article published online in Annals of Surgical Oncology.
” ‘While we await the results of level 1 evidence, these data provide valuable information that 5-day APBI in appropriately selected women can be considered as an alternative to conventional 6- to 7-week external-beam whole-breast irradiation (WBI),’ they concluded.”
Update: We are deeply saddened to report that John passed away on December 18, 2016. It is a privilege to continue to share his story and keep his memory alive.
In the summer of 2004, John Wagontall looked like the picture of health. The 46-year-old Canadian had been a firefighter for 20 years, was an avid cyclist, and also worked out alongside his wife as she trained for a bodybuilding competition. The only sign that something was wrong was a bit of blood in his urine.
His doctor told John he had a bladder infection, prescribed antibiotics, and sent him home. And all appeared to be well until a few months later, when his urine was bloody again. This time, his doctor sent him to a urologist to learn the underlying cause of his recurring bladder infection. Continue reading…