Dr Haffty on Technical and Biological Advancements in Radiotherapy Within Breast Cancer

Bruce Haffty, MD, MS, chair, Radiation Oncology, associate vice chancellor for Cancer Programs, Rutgers Cancer Institute of New Jersey, system director, Radiation Oncology, RWJBarnabas Health, discusses the significance of technical and biological advancements in approaches to radiotherapy, and how they engendered the de-escalation of radiotherapy for select patients with breast cancer.

Recent technical advancements in the field of radiation oncology have allowed clinicians to more precisely target tumors and minimize the impact of treatment on surrounding tissues, Haffty begins. The development and subsequent efficacy seen with approaches such as image-guided radiation, intensity-modulated radiation, stereotactic radiation, and adaptive radiation encapsulates these improvements, he states. The ability to deliver radiation more effectively has also paved the way for biological advancements, namely the use of accelerated radiation delivery with larger doses to smaller targets, Haffty details. This progress has facilitated the integration of radiation with chemotherapy or immunotherapy, he explains.

Overall, precise approaches to radiation enabled by technical advances allowed clinicians to reduce treatment duration for select patient populations, Haffty continues. Historically, patients with breast cancer underwent 5 to 6 weeks of radiation courses, but these improvements now allow for more efficient therapeutic delivery without increasing toxicities, he states. For many patients, the duration of treatment has been condensed to 3 to 4 weeks or, in some cases, as few as 5 sessions, Haffty emphasizes.

Ongoing studies are evaluating the feasibility and efficacy of this shorter treatment course in patients who require treatment to be targeted to both the breast and lymph nodes, which also traditionally took 5 to 6 weeks, he adds. Although final results from these studies have not yet been reported, the trend toward shorter radiation periods is evident in breast cancer, Haffty states. This paradigm shift is not limited to breast cancer; similar strategies are being employed in the treatment of prostate cancer, lung cancer, and gastrointestinal cancers, Haffty concludes.