Yale-New Haven Hospital participates in partial breast irradiation study

Study gives women new hope that less time for radiation might be needed

I’ve been interested in PBI since I did my fellowship years ago at Memorial Sloan Kettering in New York City, so when the opportunity arose at Yale-New Haven Hospital to do the study, I was elated to participate. It’s a new area of study that’s stirring a lot of interest around the country.

The study I’m coordinating is being done in cooperation with the Radiation Therapy Oncology Group and the National Surgical Adjuvant Breast and Bowel Project, two national cooperatives funded by the National Cancer Institute. Yale is one of about 100 sites across the country doing the study. The goal of the study is to have 3,000 women participate over the next three years.

PBI might give women one more option in their treatment of breast cancer.

I’m an advocate of PBI. I think it holds great promise in giving women one more option in the treatment of their breast cancer. Many women opt not to have a lumpectomy, in which only the cancerous area is removed and the breast is preserved, because it must be followed by six to seven weeks of daily radiation treatment to the whole breast. While this time commitment is inconvenient, such radiation therapy is the gold standard of care today, and is effective.

Radiation acts by killing microscopic cancer cells left in the breast after breast-conserving surgery. Women who have had radiation have a 10 percent chance of having the cancer return, while women without radiation have a 40 percent chance. Many times, women chose to have their total breast removed, or a “mastectomy,” because they can’t see themselves committing to a rigorous radiation treatment given their work and home busy schedules. With a mastectomy, no radiation is usually needed.

This study seeks to tell whether irradiating only part of the breast where the tumor was removed can be as effective as the whole breast.

This PBI study seeks to tell whether irradiating only part of the breast – the part where the tumor was removed – can be as effective as treating the whole breast. While we know this experimental treatment is safe, with minimal toxicity, we don’t know if it will be as good as the gold standard of care, which is whole breast irradiation.

PBI therapy takes a significantly shorter time because by treating only a smaller portion of the breast, normal tissues are avoided. It can be completed in five days, instead of the usual six or seven weeks. Treating this smaller area also means the potential for fewer side effects to normal organs, like the heart or lung.

What happens in the study is this: women either get the gold standard of whole breast radiation, or the new PBI treatment. PBI can be given in several ways, either by brachytherapy or external beam radiation. The study isn’t for everyone, however. It only applies to early-stage breast cancer (stages 0, 1, 2) and women who are 26 years old and up, who don’t have more than four lymph nodes involved, and have a tumor that was less than three centimeters in size.

Women need to be willing to get either treatment, as the trial is randomized, and we do not choose which type of radiation therapy they get, whole breast or PBI. Women should be lauded for wanting to participate, as they are contributing to the greater good of health for all women. I feel that our study participants can take great pride in knowing that they’re participating in a national trial that will help women all over the world. The future holds great promise for defining the optimal delivery of radiation therapy for breast cancer patients, and I’m happy to be a part of this study.

For more information, or to talk to someone about participating in this study, call 203-688-1861.

Dr. Weidhaas, MD, PhD, is an attending physician in the Department of Therapeutic Radiology, Yale-New Haven Hospital, Assistant Professor, Yale University School of Medicine, and a member of the Yale Cancer Center.

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