Early breast cancer is often treated with lumpectomy (removing just the tumor) followed by radiation to the whole breast, plus an extra “boost” dose to the tumor area afterward in selected cases. This standard approach helps our patients to retain her breast while halving the chances of tumour coming back. A small new study from Rutgers Cancer Institute flipped the order of the script: they gave the boost before surgery. As per this study, in 89 women with small, low-risk tumors (mostly older women with an average age 63 years), only 3 out of 89 (3.4%) needed a second surgery for unclear margins—which is much lower than the usual 13–17% reported in earlier studies. Total time from diagnosis to finishing radiation? Just 109 days, versus 122–126 days normally. This means less waiting, fewer operations, less stress, and quicker chemotherapy if needed.
Why This Could Be a good news
- Fewer redo surgeries or re-operations: Upfront radiation might shrink tumors for cleaner cuts. Especially when we use good imaging like MRI for precise targeting chances of missing the tumour is very rare.
- Faster overall treatment: Radiation starts sooner than surgery slots allow. Although in our institute, we make sure that the wait for surgery is not that big of an issue.
- Safe so far: Wound healing matched standard care; no big red flags.
What’s the Catch?
It’s a tiny phase II trial (89 patients), not a big randomized one like START-B that proved standard radiation over decades. Mostly early stage, good biology cases were tested in this trial. So this approach is untested for aggressive cancers. There is no long-term data on recurrence or survival yet. Surgeons in this study knew about the radiation and many a times that brings in bias. Real-world reoperation rates swing wildly (0–92%) and mostly depends on how good your surgeons are and how well behaved your disease(biology) is. Hence this special radiation may not be applicable everywhere. In a nut shell this trial is promising for efficiency, but standard postoperative radiation is proven gold for now. Lets wait for bigger and better trials! Until then, please ask your doctor if this approach is meant for you.