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

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.