Different approaches to radiation treatment of the breast

Last Modified: August 1, 2004

Dear OncoLink "Ask The Experts,"
My mother was recently diagnosed and her first treatment will likely be radiotherapy. Is 3D conformal radiation overall better than conventional external beam radiation for breast cancer? Is 3D conformal radiation only in clinical trials right now? Should we bother to choose a treatment hospital based on it having newer technologies, including brachytherapy?

Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds:

Radiation treatment to the breast can be delivered using a number of different technical approaches, and there is no single best approach for all patients. Conventional external beam radiation treatment including the whole breast is the technique that has been used to treat the largest number of patients with the longest follow-up, and therefore, has been the most widely studied. CT-based approaches have recently been developed. Intensity modulated radiation treatment (IMRT) is a newer technique that may deliver improved dose distribution for some patients. Accelerated whole breast radiation is designed to deliver the radiation treatment to the whole breast, but over a smaller number of weeks of treatment compared to more conventional radiation. Accelerated partial breast irradiation (APBI) targets the area of the breast in and around the primary tumor site, and delivers the radiation over a very compressed time frame, generally about one week. A number of different techniques have been used to deliver APBI, and include external beam radiation, brachytherapy implant (insertion of catheters into the breast to deliver radiation), intraoperative radiation, and intracavitary brachytherapy (insertion of a balloon catheter into the breast to deliver radiation).

With the development of different breast radiation treatment techniques, many studies are ongoing to evaluate these various treatment options and to define which patients are best suited to one technique or another. Some of these studies are from single hospitals or universities, and others from large cooperative groups. Many of these studies are still ongoing or will require more years of following treated patients before an analysis can be performed. One important study that will open shortly has been developed jointly by the NSABP (National Surgical Adjuvant Breast Project) and the RTOG (Radiation Therapy Oncology Group). This study will compare APBI to conventional whole breast radiation treatment.

In choosing where to get radiation treatment, a number of factors should be considered. Radiation treatment for breast cancer needs to be individualized for each individual patient. The radiation oncologist should have experience in breast cancer treatment, in general, and in using different technologies for radiating the breast. A range of different technologies should be available at the facility where the radiation treatment is being given. Finally, access to research protocols is a plus to give the widest potential range of treatment options.