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Shortened Therapy Leads to Success
Cancer cells should be destroyed
by radiation; © NCI Visuals Online
Anastacia, Kylie Minogue, Sylvie van der Vaart – just three examples of celebrity women, who have suffered from breast cancer. Even though the disease is more prevalent in women over 50, it also occasionally affects younger women. ”The number of new incidences in Germany is at a total of 40,000 to 50,000 per year,“ according to Frederik Wenz, Director of the Clinic for Radiation Therapy and Radio-Oncology at the University Medical Centre in Mannheim.
In many cases, breast cancer is curable, but the treatment is often associated with side effects for the patients. “Primarily it is a cosmetic issue“, explains Uta Kraus-Tiefenbacher, Head of Department of the same clinic where Wenz works. Skin damages like spider veins for example or pigmentary abnormalities are among them. The reason for that is the radiation after surgery.
As part of the established standard therapy after removal of the tumour, the sick breast receives outside radiation for six weeks, five times daily. By doing this, the remaining cancer cells are meant to be destroyed and cancer relapse should be prevented. In about 60 percent of all cases, this actually translates into excess therapy. “Many physicians irradiate as a prophylaxis, because they want to play it safe“, Kraus-Tiefenbacher knows. More and more hospitals are therefore looking for an alternative – and treat their patients with a new method, the so-called intra-operative radiation therapy.
Trial results surprise medical scientists
With this therapy, through a mobile device the physician is already administering one third of the total radiation dose during surgery. For 30 minutes, he irradiates the tissue where the tumour was embedded. The remaining dose is then distributed – just like in the standard procedure – after the surgery on the entire breast. The advantage: The total radiation therapy duration is being reduced from six to four-and-a half weeks. There are also less skin damaging side effects.
Physicians call this treatment Boost-Therapy. With its eight years experience, the University Medical Centre Mannheim has the most experience in this area in Germany. What’s more, it was in charge of coordinating the TARGIT-study, which has been conducted since 2000 and just ended in April of this year.
Within this study, physicians have treated over 2.000 patients using this new procedure. One preliminary result: The relapse quota could be significantly reduced. In standard treatments it ranges between three and five percent in the first five years, but with the Boost-Therapy it was reduced to 1.5 percent. “The results have far exceeded our expectations“, Wenz points out.
Despite great success, there are also risks
In the meantime, the combined treatment of intra-operative and postoperative radiation has become part of the daily routine at the University Centre Mannheim – and more and more medical centres are jumping on the bandwagon. There are already 20 treatment centres in Germany, who treat applicable patients using this procedure.
Older women exhibit more
benign types of tumours than
younger women do; © Rainer
“The most important requirement is that we operate and preserve the breast“, explains Wenz. This is especially true when the tumour was detected in its early stages and is smaller than two centimeters. Early detection screenings are therefore very important. Another criterion according to the expert is the location of the cancer. “Only if the tumour is in a geometrically favourable location, is it possible to irradiate the tumour bed optimally during surgery“. It is also necessary to conduct a technically accurate treatment, since this would otherwise increase the risk for wound healing disorders. According to the expert, there are no indications that the intensive radiation during surgery causes worse tissue damage.
At the moment, physicians are trying to determine whether radiation can be even further reduced to one time during surgery. Wenz points out though that a single radiation treatment needs to be carefully considered, otherwise there might be the danger of not having done enough therapy. Most likely it is older women with a lower risk profile, who can benefit from this type of therapy. The reason: Due to hormonal balances, older women exhibit more benign types of tumours than younger women do.
The expert hopes for more information about the use of this one time radiation treatment in the near future. “The results of the TARGIT-study pertaining to this aspect are currently being analyzed“.
(Translated by Elena O'Meara)