Dr Haffty on the Rationale for Investigating Preoperative Radiation Boosts in 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 rationale for launching a clinical trial to assess the feasibility of preoperative radiation boost in patients with breast cancer.

Patients with breast cancer who undergo a lumpectomy typically receive whole breast radiation therapy following the procedure, Haffty begins. This involves administering whole breast radiation followed by an additional radiation boost to the specific area where the lumpectomy was performed, Haffty adds. Studies conducted years ago confirmed the effectiveness of this approach and demonstrated that the boost is beneficial, he states.

One compelling reason for administering the boost before surgery rather than after is that a preoperative boost likely targets a smaller area, Haffty explains. Postoperative changes, including the surgical site and biopsy cavity, can affect the treatment area, Haffty expands. Delivering the boost before surgery allows for an increased focus on a smaller area, potentially leading to better cosmetic outcomes from treating less surrounding tissue, he says. This investigation, findings from which were presented at the 2023 ASTRO Annual Meeting, was also rooted in the possibility that preoperative radiation may stimulate an immune response within the tumor, Haffty notes. While ongoing research is needed in this area, preoperative radiation is an intriguing concept that could offer additional benefits.

Moreover, in the postoperative setting, oncoplastic surgery along with lumpectomy involves multiple surgical procedures on the breast, he continues. Determining the precise location for the boost can be challenging under these circumstances, making the preoperative boost atheoretically advantageous option, Haffty notes.

In the long term, the hope is that targeting smaller areas with a preoperative boost may lead to improved cosmetic results and fewer adverse effects, he continues. The primary aim of the study was to establish the safety of this approach regarding wound healing and to confirm that the preoperative boost does not introduce any surgery-related complications, Haffty says. Addressing these concerns is crucial to encourage acceptance of the preoperative boost among surgeons and patients alike, he concludes.