Lumpectomy combined with temporary implants of radioactive strands are as effective as mastectomy at arresting early-stage breast cancer, according to a recent study reported at the annual meeting of the Radiological Society of North America.
The study followed more than 650 middle-aged women for 10 years after treatment. According to the study, cancer was controlled for 93 percent of women with small, isolated tumors, and 87 percent for women with tumors up to 2 inches in diameter that had spread to the lymph system.
"The results are equal to mastectomy," said Dr. Carl Mansfield, professor and chairman of the department of radiation oncology and nuclear medicine at Thomas Jefferson University Hospital, Philadelphia, who conducted the study. "It's just that no one is making the change" from mastectomy, he said.
"Women and their doctors need to know about this approach," Mansfield said. "We clearly know these patients (with early-stage cancer) don't have to have a breast removed. But the majority of women in these cases are still having mastectomies," he says.
The procedure begins with a normal lumpectomy. Afterward, a doctor inserts several 3- to 5-inch thin, plastic tubes before the closing the incision. The tube ends are crimped at skin level to hold the tubes in place. Four to six hours after surgery, a strand of radioactive Iridium-192 about the thickness of a pencil lead is threaded into the tubes, delivering a high dose of radiation to the tumor site. Two to three days later, the tubes are uncrimped and removed in a painless procedure, Mansfield said. A routine five-week course of daily external radiation treatments begins about two weeks after surgery, Mansfield said.
In normal radiation treatments for breast cancer, the whole breast is irradiated, then the tumor site gets a second "boost" of radiation, Mansfield said. "The only difference is that we do the boost dose up front." Total radiation is the same, with minimal damage to normal tissue, he says.
The technique requires shorter treatment times and costs $500 to $1,000 less than conventional radiation therapy, Mansfield said.