Innovations In Radiation Therapies For Breast Cancer

After age standardisation, the burden of breast cancer in 2016 was approximately 515.4 Disability Adjusted Life Years (DALYs) per 1,00,000 women but now the projection has substantially increased, reaching 5.6 million DALYs by 2025. Breast cancer is also known as one of the most common causes of cancer-related disability and mortality in India. This complex disease presents symptoms such as breast lumps, nipple discharge, and ongoing pain, highlighting the importance of early detection. Regular self-examinations and screenings like mammograms are essential for catching potential issues early. Once diagnosed, treatment options include surgeries, chemotherapy, and hormone therapy. Among these, radiation therapy has become a critical component due to its ability to precisely target cancer cells while sparing healthy tissue. This precision is especially important given the sensitivity of breast tissue and its proximity to vital organs. Radiation therapy symbolises significant advancements in breast cancer treatment, offering hope and progress. Understanding its role is crucial for patients and their families as they navigate the path to effective treatment and recovery.

Breast cancer screening and early detection are being revolutionised by advances in imaging technologies. One well-known example is three-dimensional mammography, or tomosynthesis, which builds a three-dimensional model of the breast by taking numerous pictures from different perspectives, possibly making it easier to find smaller or less visible tumours. Though large-scale investigations like the Tomosynthesis Mammographic Imaging Screening Trial (TMIST) study are still investigating its superiority over regular 2D mammography, its growing clinical availability indicates a shift towards more comprehensive imaging. Beyond improvements in imaging, a better knowledge of the subtypes of breast cancer, especially those defined by the presence or absence of hormone receptors (HR) and human epidermal growth factor receptor 2 (HER2), is guiding more individualised screening and treatment plans. This information aids in customizing treatment choices and screening suggestions based on the unique features of each tumour, resulting in more focused and efficient treatments.

Advanced radiation therapy techniques:

There have been significant advancements in radiation oncology, offering shorter treatment durations, reduced side effects, and greater precision. Advanced computational algorithms have been deployed in delivery of radiation therapy over last 3 decades. The type of radiation therapies used for treating breast cancer available today are:

-   Intensity-Modulated Radiation Therapy (IMRT): Intensity Modulated Radiotherapy (IMRT) is a term whereby the radiation intensity is changed over the surrounding structures like lungs, heart, spinal cord at fixed angles of the treatment rotation while delivering cancericidal dose to the breast. In Volumetric Modulated Arc Therapy (VMAT), the intensity modulation happens throughout the rotation of beam delivery.

-  Image-Guided Radiation Therapy (IGRT): Image Guided radiotherapy (IGRT) alludes to taking an in room image with a virtual or real CT/MR before or during the radiation treatment delivery to precisely target the planned treatment delivery.

-  Stereotactic Body Radiation Therapy (SBRT): While more commonly used for small, early-stage tumors in other cancers, SBRT can also be applied in certain cases of early-stage breast cancer, particularly for patients who might not be candidates for traditional surgery.

-  Proton therapy: Proton therapy is particularly advantageous for younger women or those with tumors near vital structures, as it can minimise radiation exposure to surrounding healthy tissues and reduce the risk of long-term side effects. Here the radiation beam is made to stop at a specified depth without affecting the tissues through which it passes.

It is possible to have only the tumor or cancer removal and axillary sampling for stage 1&2 breast cancer with surgery without the removal of whole breast. Radiation therapy is added to sterilise the breast without altering its sensitivity, preserving the body form of woman and her sense of self. Large, randomised trials since 1980s have proven that addition of radiation therapy adds to longevity and can cure 97-98 per cent of breast cancer patients with less than 5 centimeters cancers in estrogen and progesterone receptor positive breast cancers.

Benefits of Advanced Radiation Therapy:

-        Improved Tumour Control: Advanced techniques like IMRT and SBRT allow for higher doses of radiation to be delivered directly to the tumor while minimising exposure to surrounding healthy tissue, thereby increasing the likelihood of effectively killing cancer cells.

-         Minimising Side effects: By sparing healthy tissues from radiation exposure, advanced techniques significantly reduce both immediate side effects (such as skin irritation) and long-term complications (such as fibrosis or late cardiac events).

-         Improved Quality of Life: With shorter treatment durations, reduced side effects, and quicker recovery times associated with advanced radiation therapies, patients can often return to their normal activities more quickly, enhancing their overall quality of life.

-        Higher Patient Satisfaction: Personalised treatment plans that utilise advanced radiation techniques empower patients by providing them with tailored approaches to their care, which can improve their overall satisfaction and sense of control during the treatment process.

Radiation therapy serves as a highly effective and precise treatment option in the battle against breast cancer. Gaining an understanding of the entire process—from planning to daily sessions and managing side effects—empowers patients with the knowledge and confidence necessary to navigate their treatment journey with resilience. By accepting the developments, dispelling myths, and expanding access to high-quality healthcare, we can equip women with the most powerful weapons at their disposal to combat breast cancer. Radiation therapy has a bright future ahead of it, one that will illuminate the way to a healthier and more promising future for everybody if technology keeps developing.

Dr Tejinder Kataria

Guest Author The author is the Chairperson, Radiation Oncology, Cancer Institute at Medanta Hospital.