Naamit K. Gerber, MD, assistant professor, Department of Radiation Oncology, NYU Langone’s Perlmutter Cancer Center, discusses the future landscape of radiation oncology.

The impending TAILOR RT trial will be using Oncotype to stratify patients and see if they need regional nodal irradiation or no regional nodal irradiation. Patients who have undergone a lumpectomy will get whole breast radiation versus whole breast plus regional nodal radiation. Patients who have undergone a mastectomy will either receive no radiation or radiation to the chest wall plus nodal radiation, explains Gerber.

The trial is seeking to understand which subgroups will benefit most from regional nodal irradiation. Researchers are using Oncotype as a surrogate to try to identify the patients with a worse biology. This is based on some data that shows that Oncotype not only correlates with distant recurrence but also with locoregional recurrence, says Gerber.

There is also more of a push to explore the use of hypofractionated radiation in patients who have had a mastectomy. It has become more widely adopted in early-stage breast cancer patients with intact breast, states Gerber. Partial breast radiation is commonly used at NYU Langone's Perlmutter Cancer Center, but is not as widespread as expected. In August 2017, 

 published a large study from the United Kingdom comparing partial breast to whole breast radiation in almost 2000 patients showing equivalent outcomes. Gerber hopes that partial breast radiation becomes more common as the data accumulate.

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Dr. Gerber on the Future Landscape of Radiation Oncology

Naamit K. Gerber, MD, assistant professor, Department of Radiation Oncology, NYU Langone’s Perlmutter Cancer Center, discusses advances in radiation oncology in the treatment of patients with breast cancer.

The introduction of a deep inspiration breath hold (DIBH), which moves the heart away from the left breast or chest wall, has been crucial in limiting the heart dose, Gerber says. Patients who undergo this technique are told to take a deep breath which inflates the lungs, creating more distance between the heart and the left breast. This allows radiologists to target the left breast and limit the cardiac dose. The technique is very useful in patients with early-stage breast cancer who need their breast treated, and more advanced disease for patients who need their lymph nodes treated, says Gerber.

The adoption of this technique into practice extends beyond NYU, says Gerber—it is becoming more frequent in practices across the country. Unlike some of the other advances in radiation oncology that get a lot of attention, DIBH is a simple technique with tremendous effects on patient care.

Naamit K. Gerber, MD

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