Doctor Cautions Patients On Partial-Breast Irradiation

NEW HAVEN — Partial-breast irradiation, a breast cancer treatment that has been increasing in popularity, sends intense cancer-killing beams directly to the tumor bed rather than the whole breast, and makes it possible to treat patients in one week instead of the usual six. But a top expert at Yale-New Haven Hospital is cautioning patients that the treatment is still experimental, and should be used only on selected patients.

“Partial breast irradiation is promising based on initial results,” said Yale-New Haven Hospital radiation oncologist Bruce Haffty, MD, a professor of therapeutic radiology at the Yale School of Medicine who has been included on lists of top doctors by Good Housekeeping, Ladies’ Home Journal, and New York magazines.

 “But I’d say the message is that this treatment is still investigational,” he said. “At this point, doctors should be using it to treat patients under approved protocols with very strict guidelines.”

Dr Haffty is one of many radiation oncologists throughout the country who have expressed concern that partial breast irradiation is becoming accepted and widespread too quickly.

 Treatment options often become available before they are fully proven, but researchers are working quickly to get information on whether partial breast irradiation keeps women cancer-free as long as traditional radiation, and who are the best candidates for it. Yale-New Haven Hospital plans to participate in a National Cancer Institute-funded randomized trial to look at the long-term benefits of the treatment. The hospital has been participating recently in a phase I/II study looking at the feasibility of partial breast irradiation in selected patients.

Health care centers in Connecticut are offering a number of forms of partial-breast irradiation, including MammoSite, a machine that places a radioactive seed inside the breast. Dr Haffty, who has already participated in one partial-breast irradiation clinical protocol, is performing partial breast irradiation on carefully selected patients using external beam radiation. The technique sends radiation from multiple angles that are closely tailored to the lumpectomy site.

Partial-breast irradiation appears to be most promising in women who have small, localized malignancies that have been completely removed by surgery, and negative lymph nodes, Dr Haffty said. “That would probably include up to 30 or 40 percent of patients with breast cancer,” he said.

This year, approximately 182,200 women in the United States will be diagnosed with invasive breast cancer, and 40,800 are expected to die from it, according to estimates from the American Cancer Society. Lumpectomy followed by whole-breast irradiation to eradicate stray cancer cells in surrounding tissue is now accepted as a standard of care, equally in effectiveness to mastectomy. But whole-breast radiation can take five or six weeks, which is such a hardship for some women that they sometimes end up opting for a mastectomy. It will take several more years of study to find out whether a lumpectomy with partial breast radiation is a safe alternative.

Patients who are facing breast cancer treatment and want to explore all of their options as far as radiation would do well to get a second opinion and carefully review all the facts, Dr Haffty said. “A second opinion gives you a higher level of comfort with your decision. There’s a lot of value in piece of mind,” he said.