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Stanford Report, August 6, 2003

Researchers test dramatically shortened therapy approach for breast cancer New treatment eases impact on patients’ daily lives


When Caroline Weinheimer learned she had a breast tumor, her doctors offered a choice of treatments: Surgery followed by daily radiation treatment for about six weeks or a single dose of radiation during surgery as part of a trial conducted by medical center researchers. Weinheimer, 62, opted for the single treatment. The decision enabled her to lead a normal life following surgery rather than making daily hospital visits.

"Having it all done at once lets you put it aside. It’s not hanging over you," she said. During the weeks when many other women would be commuting daily to a hospital, Weinheimer, who lives more than 60 miles away in Hollister, Calif., was able to return to work. "If I had to go to Stanford every day that would have been impossible," she said.

The trial is testing whether a single dose of radiation aimed just at the region of the breast that contains the cancer is as safe and effective as the traditional drawn-out treatment.

"We’re very happy with the initial results of the trial," said Frederick Dirbas, MD, assistant professor of surgical oncology and leader of the trial. The first five women who participated had no additional pain or scarring compared with women who receive standard therapy. The trial is recruiting additional participants with breast cancer or with precancerous conditions.

Women with early stage breast cancer usually have their tumors removed in a surgery called a lumpectomy. Doctors then administer low doses of radiation to the entire breast each day for the next six and a half weeks to kill any remaining cancer cells. Although this technique works well, it is inconvenient especially for women who live far from their treatment center, don’t have transportation, or who can’t leave work or their families to receive the radiation.

An Italian trial was the first to test using a single, high dose of radiation during the lumpectomy to kill remaining cancer cells. Unlike traditional whole-breast treatment, the Italian group directed cancer-destroying radiation to the breast region that contained the cancerous cells. Two years after treating more than 100 patients, the group has found the approach to be safe and effective.

In the first such trial in the United States, Dirbas and Donald Goffinet, MD, professor of radiation oncology, hope to test the high-dose radiation in 50 women. The trial was initially set up for women with invasive breast cancer, but the researchers are now including women with a precancerous condition called ductal carcinoma in situ, or DCIS.

In the initial five patients who had the single dose treatment, Dirbas said the women healed normally. Two had breast cancers and three had DCIS. "Recovery is indistinguishable from normal therapy," he said. The researchers found no infections and no wound-healing problems and the women did not seem to experience any more pain than those who received standard therapy. Weinheimer agreed that the procedure wasn’t particularly painful. "It’s healing beautifully," she added.

In this first group of women, Dirbas said the single-dose regimen appears to be as effective as the lengthier treatment, but he noted that it is still too early to tell. "The results of the European study are promising and our early results suggest that patients can tolerate the single higher dose well."

Those interested in participating in the trial should contact Triona Dolphin or Janelle Maxwell at 498-7740.

Study shows surgery not always necessary in treating breast cancer (5/2/01)