“An expert panel convened by the American Society for Radiation Oncology (ASTRO) released a set of recommendations regarding fractionation for whole-breast irradiation (WBI) in women with breast cancer. The guideline includes recommendations for standard practice, factors that should influence fractionation decision making, and issues surrounding tumor bed boost, among other issues.
” ‘Breast cancer is the most common malignancy treated with radiation therapy in the United States, and WBI is the most common radiotherapeutic approach for breast cancer,’ wrote authors led by Benjamin D. Smith, MD, of MD Anderson Cancer Center in Houston. The standard of care for WBI has involved conventional fractionation (CF), with daily doses of 180 to 200 cGy up to approximately 4,500 to 5,000 cGy; research in the 1990s and 2000s looked into whether moderate hypofractionation (HF) with daily doses of 265 to 330 cGy could offer similar outcomes.”
“Adjuvant radiotherapy appeared associated with better outcomes than surveillance followed by early-salvage radiotherapy among patients with prostate cancer with adverse pathological features who underwent prostatectomy, according to study results published in JAMA Oncology.
” ‘It remains very controversial whether patients with high-risk features after a radical prostatectomy for prostate cancer should receive adjuvant radiation therapy to prevent a recurrence of their prostate cancer as measured by a rise in PSA, or whether we should observe patients after surgery and only radiate those who demonstrate a detectable PSA,’ Rahul D. Tendulkar, MD, of the department of radiation oncology at Cleveland Clinic, told HemOnc Today.”
“Endocrine therapy can achieve tumor reduction for patients with ER-positive breast cancer, possibly avoiding the need for chemotherapy or even surgery in some patients; however, deciding how long to continue this therapy can be tricky, said Hyman B. Muss, MD, who presented at the 2018 Miami Breast Cancer Conference.
” ‘It can improve the probability of breast preservation for women who would appropriately fit in [related] studies and don’t have very high-grade or aggressive tumors,’ said Muss, of the Lineberger Comprehensive Cancer Center, University of North Carolina, and a 2017 Giants of Cancer Care® winner. ‘The optimal duration is 3 to 6 months. I think it’s [also] worth considering this in postmenopausal women with larger tumors.’ ”
This post is written by ASK Cancer Commons Scientist and Product Team Member Amanda Nottke, PhD. Dr. Nottke regularly provides guidance to patients through our ASK Cancer Commons service.
After a diagnosis of early stage, hormone-positive breast cancer, you may find yourself facing several daunting decisions, such as choosing between the extensive surgery of mastectomy versus a more minor lumpectomy procedure paired with radiation (with all its challenging side effects). And once surgery is complete, what next? Hormone therapy is clearly indicated for many women, but which drug, and how long to take it? And what about chemo—how to know if the tough side effects are worth the possible reduction in risk of recurrence?
Fortunately, there are a wealth of quality datasets available to inform these decisions. Below are some of the questions we get most frequently from patients using our ASK Cancer Commons service, answered according to the latest thinking from scientific literature and our expert physician network. If you are facing your own cancer treatment decisions and would like free one-one-one expert support, please submit your case here.
1. If my doctor has said either mastectomy or lumpectomy plus radiation are appropriate for me, how do I choose?
Many studies have looked at this, and overall the outcomes for mastectomy versus lumpectomy plus radiation are extremely similar (both are effective treatments, so you can instead weigh the side effects of radiation versus the more intensive surgery of the mastectomy). This webpage provides a helpful summary of the pros and cons of mastectomy compared to lumpectomy.Continue reading…
“Wilmot Cancer Institute patients with advanced melanoma (stage III) now have more options for treatment, thanks to research co-authored by a University of Rochester Medical Center surgical oncologist and published in The Lancet Oncology.
“The study involved comparing two treatment approaches for high-risk melanoma patients with a BRAF gene mutation in their cancer: standard care, which calls for upfront surgery, or giving a two-drug, targeted therapy regimen before surgery and again afterward. Patients in the latter group had longer disease-free survival in the Phase 2 trial, and after seven months researchers halted the study earlier than expected due to the positive results.”
“Traditional neoadjuvant chemotherapy along with dual HER2-targeted blockade yielded significantly better response rates than a novel approach using HER2-targeted chemotherapy plus HER2-targeted blockade, according to a randomized phase III trial.
” ‘Despite the improvements in outcomes associated with HER2-directed therapy, approximately a quarter of patients who receive treatment for their early breast cancer remain at risk of relapse after 8–10 years, and around 15% will die within a decade,’ wrote study authors led by Sara A. Hurvitz, MD, of the David Geffen School of Medicine at the University of California, Los Angeles. A need for new strategies in this setting led the investigators to test a neoadjuvant regimen of the antibody–drug conjugate trastuzumab emtansine along with pertuzumab in comparison with traditional systemic chemotherapy along with trastuzumab plus pertuzumab.”
“For prostate cancer patients who have rising levels of PSA (a cancer indicator) even after radical prostatectomy, early treatment makes a difference. In a study featured in the December issue of The Journal of Nuclear Medicine, Australian researchers demonstrate that PET scans can identify which of these prostate cancer patients would benefit from salvage radiation treatment (SRT).
” ‘The research is novel because it looks at the impact of PSMA PET/CT on patient responses to treatment, not just on whether the PET scan results in changed management,’ explains Louise Emmett, MD, of the St. Vincent’s Hospital, Sydney, Australia. She elaborates, ‘In the study, these patients underwent imaging with a PSMA PET scan and had treatment based on the results of the scan findings. The study then followed how these men were treated, and whether the treatment was effective.’ ”
Johns Hopkins Bloomberg School of Public Health | Nov 1, 2017
“Nearly one-third of women with breast cancer went against their doctor’s advice and chose not to begin or complete the recommended adjuvant anti-cancer therapy to kill residual tumor cells following surgery, according to a study led by a Johns Hopkins Bloomberg School of Public Health researcher.
“A survey that included 2,754 breast cancer patients in Florida and Pennsylvania during a two-year period found that this ‘treatment discordance’ – not following a doctor’s recommended treatment plan in its entirety – was more likely among patients who reported a general distrust of medical institutions and insurers. The patients’ trust or distrust of their own doctors did not seem to be a factor.”
“Several patients with recurring glioblastoma, a deadly brain cancer, survived for more than a year in a clinical trial believed to be the first to use comprehensive DNA and RNA sequencing of a patient’s tumor to inform treatment for these patients in real-time. The study was led by the Translational Genomics Research Institute (TGen), UC San Francisco (UCSF) and the Ivy Foundation Early Phase Clinical Trials Consortium.”