Analysis Finds One-Dose Radiation Effective in Treatment of Breast Cancer

One dose of radiation during surgery for early breast cancer is as effective as six weeks of standard treatment – which could save as much as $1.5 billion in the United States over five years.

A new analysis by the University of California, San Francisco (UCSF) found that intraoperative radiotherapy was not only safe and effective, but so economical it could change clinical practice for some forms of breast cancer.

Of the approximately 200,000 women diagnosed annually with breast cancer in the United States, nearly 40 percent would be eligible for the treatment, said Michael D. Alvarado, MD, a breast cancer surgeon at the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center.

More than 2,000 women with invasive ductal carcinoma are participating in an international trial to test the effectiveness and rate of breast cancer recurrence with the one-dose type of radiation. So far, nearly 1,000 women have completed four years of follow up. UCSF is the lead cancer trial site in the United States and Alvarado is UCSF’s principal investigator.

In the trial, the single dose of radiation is administered in the operating room immediately after the patient’s tumor is removed. A miniature electron beam-drive device is surgically positioned in the tumor bed and radiation switched on for 20 to 30 minutes to target tissues at highest risk of local recurrence. Previous studies have found a similar rate of complications between intraoperative radiation therapy and conventional external beam treatment: about 3 percent for both.

The new study focused on the cost-effectiveness of the treatment, finding that standard treatment on average costs $8,378, nearly double the $4,705for one-dose radiation. The results could significantly impact treatment for patients and the overall health care system because the patient receives all required radiation before awakening from surgery instead of returning daily for radiation treatment.   

"The era of ‘one size fits all’ in breast cancer treatment is changing,’’ Alvarado said. “Both surgical oncology and medical oncology are making treatment recommendations based on patient-specific characteristics. This technology now allows the radiation oncologist to provide more options for individualized care."