Jean Wright, MD, director of the Breast Cancer Program, Department of Radiation Oncology and Molecular Radiation Sciences, associate professor of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, discusses the benefit of moderate hypofractionation in patients for adjuvant radiotherapy in patients with early-stage breast cancer.

 Miami Breast Cancer Conference®, Wright and Atif Khan, MD, MS, of Memorial Sloan Kettering Cancer Center, debated the use of 5 fractions or 15 fractions for adjuvant radiotherapy in early-stage breast cancer. In the debate, Wright argued for that 15 fractions should be used for the majority of patients in this setting. This approach is know as moderate hypofractionation. Two large, randomized studies conducted globally now have long-term follow-up of at least 10 years, which compared moderate hypofractionation to what was previously the standard radiation therapy of 5 weeks or longer, Wright expands.

Those studies showed that moderate hypofractionation is equally efficacious compared with the traditional form of radiotherapy, Wright notes. Moderate hypofractionation was associated with lower toxicity, both in the acute timeframe during the administration of radiotherapy and the ensuing months, as well as late toxicities that can emerge long after radiation therapy is completed, Wright continues. These robust datasets support the use of moderate hypofractionation, Wright adds.

Additionally, the ASTRO Whole Breast Irradiation Guideline endorses moderate hypofractionation as the preferred strategy in this patient population, Wright adds. These guidelines are based on those randomized trials, as well as a wide range of institutional datasets and consortiums that have further validated this hypothesis in a broad range of patients, Wright concludes.

Videos

Jean Wright, MD, discusses the benefit of moderate hypofractionation in patients for adjuvant radiotherapy in patients with early-stage breast cancer.

Dr. Wright on the Benefit of Moderate Hypofractionation in Early-Stage Breast Cancer

Jean Wright, MD, director of the Breast Cancer Program, Department of Radiation Oncology and Molecular Radiation Sciences and associate professor of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins Medicine, discusses radiation considerations in breast cancer.

Radiation decisions in breast cancer are no longer viewed as a one-size-fits-all approach, says Wright. There is a lot of nuance, in terms of deciding the optimal fields that should be treated, the optimal dose and length of treatment, and whether patients really need radiation at all, adds Wright.

Additionally, it is important to raise awareness on the studies that are being conducted in this space. Although these trials are not available at every center, it is important to know whether they are available and to consider which patients are appropriate for them to help answer remaining questions in the field, concludes Wright.

Jean Wright, MD, discusses radiation considerations in breast cancer.

Dr. Wright on Radiation Considerations in Breast Cancer

Additionally, it is important to raise awareness on the studies that are being conducted in this space. Although these trials are not available at every center, it is important to know whether they are available and to consider which patients are appropriate for them to helpanswer remaining questions in the field, concludes Wright.

Jean Wright, MD, discusses radiation considerations in breast cancer.

Jean Wright, MD, director of the Breast Cancer Program, Department of Radiation Oncology and Molecular Radiation Sciences and associate professor of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins Medicine, discusses proton versus photon radiotherapy in breast cancer.

Protons been available in radiation oncology for a few decades; however, they have recently garnered a lot of attention, says Wright. In the past, only 2 radiation oncology centers in the country had protons; now, over 20 of these centers exist and there are more to come, Wright adds.

In breast cancer, the main potential benefit of proton therapy is reducing the radiation exposure to the heart and lungs versus photon-based techniques, explains Wright. It is possible that proton therapy has somewhat different biological properties in the way that it interacts with tissues; however, most likely, it has a similar effect on the tissues as photon radiation, concludes Wright.

Jean Wright, MD, discusses proton versus photon radiotherapy in breast cancer.

Dr. Wright on Proton Versus Photon Radiotherapy in Breast Cancer

Jean Wright, MD, director of the Breast Cancer Program and associate professor of radiation oncology and molecular radiation sciences at Johns Hopkins Medicine, discusses key strategies in using radiation therapy to treat patients with breast cancer.

Radiation therapy is being tailored to reduce the radiation dose for each patient to make it safer and more appropriate for the patient’s disease, explains Wright. Some patients can omit radiation altogether. There is a defined subset of low-risk patients who may not need radiation therapy after a lumpectomy, typically women older than 70 years old with low-risk features, says Wright.

Future research will look to identify younger patients who have equally low risk of recurrence. Questions currently being asked to define this subset of low-risk younger women include, “How do we find those women?” and, “What types of tests do we need to do to determine who they are?”

Response to preoperative systemic therapies also guide radiation decisions, according to Wright. Early studies thought that any woman with a certain number of positive lymph nodes should receive radiation, but now there is a study that asks, “If a patient has lymph node—positive disease, but has a good response to preoperative systemic therapy, can [she be spared] postmastectomy radiation or regional lymph node radiation? Can response to chemotherapy help us tailor decisions in that setting?”

Furthermore, research is investigating the way technology, such as protons, is used to reduce morbidity in breast cancer radiation, concludes Wright.

Jean Wright, MD, discusses key strategies in using radiation therapy to treat patients with breast cancer.

Jean Wright, MD

Articles

Dr. Wright on the Benefit of Moderate Hypofractionation in Early-Stage Breast Cancer

Dr. Wright on Radiation Considerations in Breast Cancer

Dr. Wright on Radiation Considerations in Breast Cancer

Dr. Wright on Proton Versus Photon Radiotherapy in Breast Cancer

Dr. Wright on Key Strategies in Using Radiation in Breast Cancer Treatment