Our Summary

This research paper reviews tests of a treatment for early-stage breast cancer called partial breast irradiation (PBI). PBI focuses radiation therapy on a smaller area around where the tumor was removed in a lumpectomy, instead of the whole breast. This helps to reduce the amount of healthy tissue that gets exposed to radiation. Previous data suggested that this method was promising, but further tests were needed to confirm this. The paper discusses the results of these tests, including two large studies, the NSABP B39/RTOG 0413 and the Canadian RAPID trials. It also discusses different PBI techniques, dose schedules, and how to select the right patients for this treatment.

FAQs

  1. What is partial breast irradiation (PBI) and how is it used in early-stage breast cancer treatment?
  2. What are the results of the randomized controlled trials comparing whole breast irradiation to PBI?
  3. How are PBI techniques, dose/fractionation schedules, and patient selection determined?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumpectomy is to follow up with radiation therapy, either through whole breast irradiation or partial breast irradiation (PBI), to reduce the risk of cancer recurrence in the treated area. PBI specifically targets the area surrounding the lumpectomy cavity, minimizing radiation exposure to normal tissues. It is important to discuss with your doctor which radiation therapy option is best for you based on your individual case and treatment goals.

Suitable For

Patients who are typically recommended lumpectomy include those with early-stage breast cancer who are candidates for breast-conserving surgery. Lumpectomy may be recommended for patients with smaller tumors, tumors that are not located close to the chest wall or nipple, and tumors that are not located in multiple areas of the breast. Additionally, lumpectomy may be recommended for patients with no evidence of distant metastasis and who are able to tolerate adjuvant radiation therapy. Lumpectomy may also be recommended for patients who have a strong desire to preserve their breast and who understand the potential risks and benefits of this treatment option.

Timeline

Before lumpectomy:

  1. Patient is diagnosed with early-stage breast cancer and consults with a medical oncologist and a radiation oncologist.
  2. Patient undergoes pre-operative imaging and staging to determine the extent of the cancer.
  3. A treatment plan is developed, which may include chemotherapy, hormonal therapy, and/or radiation therapy.
  4. Patient undergoes lumpectomy surgery to remove the tumor and surrounding tissue.

After lumpectomy:

  1. Patient may experience pain, swelling, and bruising at the surgical site.
  2. Patient may be prescribed pain medication and instructed on wound care.
  3. Pathology report confirms the extent of the cancer removed during surgery.
  4. Patient begins radiation therapy, which may include whole breast irradiation or partial breast irradiation.
  5. Radiation therapy is typically given daily for a few weeks.
  6. Patient may experience fatigue, skin irritation, and changes in breast appearance during and after radiation therapy.
  7. Follow-up appointments are scheduled to monitor the patient’s progress and assess for any signs of recurrence.

What to Ask Your Doctor

  1. What are the potential risks and benefits of choosing a lumpectomy over other treatment options?

  2. How will the lumpectomy be performed and what can I expect during the procedure?

  3. What is the expected recovery time after a lumpectomy and when can I resume normal activities?

  4. Will I need any additional treatments, such as radiation therapy or chemotherapy, after the lumpectomy?

  5. What are the potential long-term side effects of a lumpectomy and how can they be managed?

  6. How often will I need follow-up appointments after the lumpectomy?

  7. What are the chances of the cancer coming back after a lumpectomy compared to other treatment options?

  8. Are there any clinical trials or new treatments that I should consider in addition to a lumpectomy?

  9. How experienced are you in performing lumpectomies and what is your success rate with this procedure?

  10. Can you provide me with more information about partial breast irradiation and how it compares to whole breast irradiation in terms of effectiveness and side effects?

Reference

Authors: Hepel JT, Wazer DE. Journal: Clin Breast Cancer. 2021 Apr;21(2):96-102. doi: 10.1016/j.clbc.2020.04.003. Epub 2020 Apr 17. PMID: 32448706