CAROLINA REGIONAL CANCER CENTER ANNOUNCES PILOT PROGRAM FOR ADAPTIVE TREATMENT PLANNING TO FURTHER EXPAND THE BENEFITS OF ITS TOMOTHERAPY HI•ART TREATMENT SYSTEM

Carolina Regional Cancer Center (CRCC), an affiliate of MUSC Hollings Cancer Center, has initiated a Pilot Program to study the benefits of Adaptive Treatment Planning utilizing the TomoTherapy® Hi•Art® Treatment System, one of the most effective forms of radiation treatment available.  Adaptive tr... [read more]

CAROLINA REGIONAL CANCER CENTER WELCOMES NEWS AS AFFILIATE, MUSC HOLLINGS CANCER CENTER, RECEIVES PRESTIGIOUS DESIGNATION BY NATIONAL CANCER INSTITUTE

Carolina Regional Cancer Center (CRCC), affiliated with the Medical University of South Carolina (MUSC) Hollings Cancer Center (HCC), announced today that HCC recently received designation by the National Cancer Institute (NCI) as one of the top cancer research centers in the country. HCC is one of only 64 other can... [read more]

Breast Cancer Treatment

One of the 1st steps in determining treatment is to evaluate whether a women desires and is a candidate for breast conservation.  If so lumpectomy and sentinel lymph node (SLN) biopsy is usually performed.  SLN biopsy is most often used in early stage patients with no obvious lymph nodes on physical exam or imaging.   One to several lymph nodes are removed.  If these lymph nodes are negative then traditional axillary dissection where the whole axially fat pad is removed can be avoided, thus significantly lowering the risk of arm swelling.   If the sentinel lymph node is positive often axillary dissection is performed, however this is a current area of investigation.  

Once all information about the primary breast mass, lymph nodes and other appropriate scans of the rest of the body have been obtained a treatment decision should be obtained in a multidisciplinary approach.  This usually involves evaluation by a surgeon, medical oncologist and radiation oncologist.
Treatment for breast cancer can be thought of in two parts.  First, what is done for the breast and then what is needed for the rest of the body.  There are three local treatment options.  These are mastectomy, lumpectomy and radiation (breast conservation) and lumpectomy alone.  Historically, mastectomy was considered the standard local treatment for breast cancer.   William Halstead, a surgeon at Johns Hopkins University in 1895, presented a theory in which he described the spread of cancer from the breast to the lymph nodes.  He was the 1st to perform mastectomy and axillary lymph node dissection for breast cancer.   However, beginning in the 1970s a second local treatment option for breast cancer treatment was investigated.  This was called breast conservation, and included removal of the mass (lumpectomy) with the addition of 5-6 weeks of breast radiation.  Several very large randomized trials showed equivalent survival between mastectomy and breast conservation.

However, not everyone is eligible for breast conservation.  First, an acceptable cosmetic outcome should be expected.  Therefore, if the tumor occupies a large proportion of the breast, lumpectomy and radiation is not desirable.  There should only be one primary lesion. Patients with more than one lump in their breast should not be treated in this manner. Mammographic calcifications should be located in only one quadrant of the breast.  Also, the tumor should not be present at the surgical margins of resection when reviewed by the pathologist.  

The radiation the thousands of women received in the above-mentioned studies was whole breast radiation for 5 to 6 weeks.   Whole breast radiation is still considered standard radiation but shorter courses of partial breast radiation have shown promising results.   Therefore, because of the excellent outcomes and limited side effects for patients with early stage disease that are treated with whole breast radiation the physicians at Carolina Regional Cancer Center currently offer shorter course partial breast radiation on an NCI funded trial comparing it to whole breast radiation for those patients who are eligible.  
The option of lumpectomy without radiation is not considered standard treatment.  In general the risk of recurrence after lumpectomy alone is 3-4 % per year of survival compared to < 1% with radiation after lumpectomy.  In other words, a women who has a 10-year life expectancy has an ~ 40% chance of recurrence if only lumpectomy is performed compared to less than 10% with radiation.  The omission of breast radiation may be considered for women with other serious medical problems and short life expectancies.  Also in elderly women with non-invasive breast cancer with small tumors and good surgical margins lumpectomy alone is an option. 
Despite good local treatment with mastectomy or lumpectomy and radiation women with invasive breast cancer are still at risk for spread of disease to other parts of the body.   Several factors determine the degree of risk and the need for additional therapy such as chemotherapy, hormonal therapy or both.  Traditionally, these have included tumor size, lymph nodes involved with breast cancer, tumor grade and hormone receptor status.   More recently genetic testing of the tumor has provided valuable information on those women who may benefit from chemotherapy. 
 
Finally, some women who choose to have mastectomy may still benefit from radiation to the chest wall and/or regional lymph nodes.  In general, these include women with large tumors, positive margins at time of mastectomy and when the lymph nodes are involved with breast cancer.