Oncologist tries to allay radiation therapy fears

Lisa Aycock heard all of the horror stories after she told people she was going to get radiation therapy to help treat her breast cancer.

"Everybody and their brother knows somebody who has had radiation," she said. "Some people would tell me really negative things about radiation, so of course I was concerned."

Her radiation oncologist, Jed Howington, was able to allay those fears, which he says were likely based on old stories about a therapy that has become much more refined and well-tolerated.

More women are likely getting radiation as early detection allows them to choose breast-conserving surgery that is followed by radiation. Yet it appears to be one of the least understood treatment options for breast cancer. Much that is known might be outdated, said Dr. Howington of Radiation Oncology Associates.

"They say, 'My dad or mom got radiation 20 years ago and I just remember them being all burned up,' " he said. "So much has changed since then."

That includes, for breast cancer, the possibility of delivering radiation just to the tumor bed in the breast through a process called brachytherapy.

After a lumpectomy to remove the tumor, a balloon with a radioactive seed is inserted into the cavity twice a day for five days. The therapy is based on the idea that if a recurrence happens, it will be within a centimeter or two of the original tumor site, Dr. Howington said. The process has been refined since it began about eight years ago to include better shaping of the balloon to avoid irradiating the skin and to better define where the seeds go in the cavity, he said.

The treatment is only for women with smaller tumors whose cancer has not spread to the lymph nodes, Dr. Howington said, but it helps radiation oncologists potentially avoid irradiating the whole breast when it might not be beneficial.

"We're seeing that in some populations of patients that may still be overkill, depending upon the specifics of their actual tumor," Dr. Howington said.

For those patients where it is appropriate, it is a chance to treat their breast cancer while keeping them as whole as possible, said general surgeon and surgical oncologist Jack A. Feldman of General Surgery and Oncology Associates of Augusta.

"They have their breast, they have very little cosmetic defect, they've had a full course of radiation therapy, and that's really the newest and most appropriate method for breast cancer," he said. About a dozen studies comparing partial breast irradiation with general breast irradiation have shown roughly equivalent results in patients who received it appropriately, Dr. Howington said. However, a national, randomized control clinical trial comparing the two is under way and might settle it once and for all, he said.

"It's needed to establish in probably most physicians' minds that it actually is equivalent," he said. "We already believe that it is equivalent" based on clinical evidence and the retrospective studies.

Even those who are getting the standard radiation therapy do much better than patients in previous years, said Carolyn Cook, a breast health nurse navigator at Cancer Care Institute of Carolina at Aiken Regional Medical Centers.

"The treatment is so much better," she said. "And the way it is administered is totally different."

Once her cancer was diagnosed as early or stage 1, Mrs. Aycock had a lumpectomy and started six weeks of radiation therapy, which will conclude this week. Other than a little blistering on her skin, she feels she has done very well.

"They caught it early," she said. "To have breast cancer, everything has been as positive as it could possibly be."

Reach Tom Corwin at (706) 823-3213 or tom.corwin@augustachronicle.com.

THE SERIES

OCT. 1: Attitude is everything when facing a diagnosis.

OCT. 4: Some women are opting for removing more in surgery.

OCT. 11: Chemotherapy more closely targets cancer cells.

TODAY: More patients might get radiation, and they have more options.

OCT. 25: There are more survivors, and age influences what that means.