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A shorter, more intense course of whole-breast radiation works as well as the traditional six-week course, at least for some early-stage breast cancers, a new study shows.

“This concept of a shorter length of treatment is gaining acceptance,” said Dr. Manjeet Chadha, associate chair of radiation oncology at Beth Israel Medical Center and associate professor of radiation oncology at Albert Einstein College of Medicine, both in New York City. Chadha led the study and is scheduled to present the results Wednesday at the American Society for Radiation Oncology annual meeting, in Chicago.

Researchers previously have tried to investigate whether they can alter the duration of radiation therapy or the volume, Chadha said. “My study focuses on the duration of it,” she said.

In her three-week treatment — called accelerated hypofractionated whole breast irradiation — a woman gets the entire affected breast irradiated and receives a ”boost,” or extra dose, at the site where the tumor was removed. Other approaches include giving a boost dose after the entire radiation treatment to the whole breast is completed.

Chadha’s study is ongoing, but she planned to report on 122 patients with early-stage breast cancers who underwent lumpectomies followed by the accelerated treatment. They were then tracked for a median of two and a half years (half followed longer, half less). The patients’ median age was 66.

No relapses were noted, and the three-year survival rate was nearly 95 percent, Chadha said.

”It sounds encouraging,” she said of her results. To further evaluate the accelerated treatment, she compared the first 50 patients on the briefer approach to a matched group of 70 patients who got the more traditional six-week radiation treatment.

Side effects, such as skin irritation and redness, were similar, she found. ”There was no difference in fatigue or breast edema [swelling],” she said. The cosmetic results were satisfactory, too.

The new study adds some valuable information for doctors trying to decide for individual women which radiation treatment approach might be best, said Dr. Nayana Vora, a professor of radiation oncology and associate member of the developmental cancer therapeutics program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

”It’s a short follow-up,” she said, noting that some side effects may surface later. But, she noted that a study outside the United States that looked at the briefer treatments has followed patients for up to 12 years with results similar to Chadha’s study.

”Very few studies have been documented in the U.S. with external whole beam [to the whole breast] and a concomitant boost,” Vora said. ”It tell us that, yes, patients can be treated with a short course of radiation treatment. Will it become the standard of care? I don’t know.”

While Vora typically offers her patients the six-week treatment unless they can’t commit to that time period because of transportation problem or other obstacles, she said she now may consider the shorter treatment.

In another study to be presented at the oncology meeting, researchers reported that breast cancer patients who have a mastectomy and then receive radiation to the lymph nodes behind the breast bone (the internal mammary lymph nodes) do not live longer than those who don’t get those nodes treated.

The study evaluated 1,334 women with stage 1 or 2 breast cancers that had spread to the axillary lymph nodes under the arms or whose original tumor was in a central, internal location. All got radiation to the chest wall and nodes above the collar bone. But half got the internal mammary radiation and half did not.

After a decade, survival differences between the groups were small, with 60 percent of those who didn’t get the extra radiation still alive, and 63 percent of those who got it surviving.

Most radiation oncologists are reluctant to radiate the internal mammary nodes, Vora explained, because of their proximity to the heart.

Many patients don’t like how long it takes to receive the results of radiology tests and aren’t happy with the lack of information when they do get the results, a U.S. study has found.

Radiology imaging tests include MRI, CT, ultrasound, mammography and X-ray.

“Most of the patients in our study were decidedly dissatisfied with how they find out about their radiology test results. Specifically, they were unhappy with the delay before getting results and the lack of detail when they do find out what the tests showed,” lead investigator Dr. Annette J. Johnson, an associate professor of radiology at Wake Forest University School of Medicine, said in a university news release.

“The classic, most common story we heard was that the patient went to her doctor for a symptom such as pain, was sent for an MRI and then heard nothing until their next regular doctor’s appointment,” Johnson said. “Then, when the patient asked what the MRI showed, her doctor gave a generic answer — ‘Everything was fine.’ The patients in our study said that they don’t want to hear ‘fine’ weeks after the test. They want to know details and they want to know them as soon as the results are in.”

The patients in the study were asked about their experiences with radiology imaging tests, what they want to know from the tests, and how they would like to learn about the results.

Johnson and colleagues found that patients “want their results quickly, in writing, and they want detailed information about the test results in language they can understand.”

Many patients said they’d like a secure way to see their results online as soon as they’re available. That would give them time before the next doctor’s appointment to prepare questions, learn more about their condition or disease, and get a jump on setting up referrals if needed. Being able to see their test results would help them play an active role in their care.

The National Institute on Aging (NIA), part of the National Institutes of Health, today announced the award of $29.5 million in grant support over the next two years to determine whether a specific physical activity program can stave off disability in older people. The funding will begin the Lifestyle Interventions and Independence for Elders — LIFE — trial, the largest ever undertaken to prevent mobility disability among older people who are at risk of losing their ability to walk and to live independently in the community. The grant is being awarded to the University of Florida’s Institute on Aging in Gainesville.

The first two years of the six-year, eight-site LIFE trial are being funded through the American Recovery and Reinvestment Act. The grants are part of the $5 billion that President Obama announced Sept. 30 on the NIH campus.

“There is a lot of evidence indicating that exercise can help in preventing diseases, such as diabetes, among older people. But we do not know whether and how a specific regimen might prevent walking disability in older people who are at risk of losing mobility,” said NIA Director Richard J. Hodes, M.D. “This research is critically important at a time when the population is aging and new interventions should be sought to keep people healthy and functioning in the community longer.”

At eight sites around the country, LIFE will involve 1,600 people aged 70 to 89, who at the start of the study meet its criteria for risk of walking disability, defined as the inability to walk a quarter of a mile or four blocks. About 200 participants will be enrolled at each of the study sites, which include the University of Florida; the University of Pittsburgh; Northwestern University School of Medicine in Chicago; Stanford University in Palo Alto, Calif.; Pennington Biomedical Research Center in Baton Rouge, La.; Yale University in New Haven, Conn.; Tufts University in Boston and Wake Forest University School of Medicine in Winston-Salem, N.C. Wake Forest will also coordinate the data management and analysis.

“Limitations in walking ability compromise independence and contribute to the need for assistive care,” said Evan C. Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology, whose program is overseeing the trial. “Older people with impaired walking are less likely to remain in the community, have higher rates of certain diseases and death, and experience a poorer quality of life. A successful intervention might help prevent these bad outcomes.”

“We know that many older people have chronic health problems that affect their ability to walk,” said Jack Guralnik, M.D., Ph.D., chief of the NIA’s Laboratory of Epidemiology, Demography and Biometry and co-principal investigator of the study. “Arthritis, muscle weakness and poor balance can all affect how well and how far a person can walk. And, some older people have all of these problems. We will test the LIFE intervention in this population to see how it works in a real-world setting.”

Study participants will be randomly assigned to one of two groups. One group will follow a structured intervention consisting of walking at moderate intensity, stretching, balance and lower extremity strength training; the control group will participate in a health education program. The participants will be followed for about three years. Researchers will evaluate whether, compared to health education, the physical activity intervention reduces the risk of major walking disability, serious fall injuries and disability in activities of daily living, and whether it improves cognitive function. They will also assess the cost-effectiveness of the intervention.

“This will be the largest randomized controlled trial to prevent major mobility disability ever conducted in older persons who are at high risk of losing their physical independence,” said Marco Pahor, M.D., director of the University of Florida’s Institute on Aging and study principal investigator. “Typically, this population is excluded from large trials, and from this perspective the LIFE study is unique.”

People with lung cancer who are screened for a genetic mutation and then given a drug called Tarceva, which is believed to work well with that mutation, live longer than those without the mutation who take the drug, new research has found.

According to the Spanish authors of a study in the Aug. 20 issue of the New England Journal of Medicine, this type of widespread screening is actually doable and could lead to better decisions about treatment.

“They proved that it is worthy to test patients for the [epidermal growth factor receptor gene] mutations, and that if you have the mutations you are going to do well,” said Dr. Edgardo Santos, an assistant professor of medicine in the hematology and oncology section at the University of Miami’s Sylvester Comprehensive Cancer Center. “If we are moving toward personalized medicine in the future, I think this is the way to go — that patients be tested and use the drug if indicated.”

People who have advanced non-small-cell lung cancer who also have certain mutations in the epidermal growth factor receptor gene (EGFR) tend to respond better to Tarceva and Iressa. Both of these drugs are tyrosine kinase inhibitors, which interfere with cancer cells’ ability to multiply. Non-small-cell lung cancer is the most common form of lung cancer.

The researchers screened lung cancer samples from 2,105 people at 129 institutions in Spain for two different EGFR mutations.

Those with mutations (16.6 percent of the sample, considered a sizable proportion) were put on Tarceva. They survived a median of 14 months without progression of their disease and 27 months overall, more than twice as long as the rates seen in other treatment groups, Santos said. This was true regardless of whether Tarceva was given as first-line, second-line or third-line therapy.

“Basically, this highlights the fact that patients with EGFR mutations should, sometime during the course of their illness, get erlotinib [Tarceva],” said Dr. George Simon, director of thoracic oncology at Fox Chase Cancer Center in Philadelphia. “However, I think for reasons of quality of life and ease of administration and differences in toxicity profiles, it may still be preferable to give gefitinib [Iressa] first-line.”

But a big question still to be worked out is why people still succumbed to the disease.

“They all had progressive disease, which basically means they had developed mechanisms of resistance,” Simon said. “We need to study what were these mechanisms of resistance and how can we counteract them, developing methods of either prevention of the emergence of resistance or treatment once resistance has emerged.”

A second study in the same issue of the journal, conducted in East Asia, found that Iressa worked better than a chemotherapy regimen of carboplatin-paclitaxel as a first-line treatment for nonsmokers and former light smokers who also had non-small-cell lung cancer.

Here again, people with the EGFR mutation responded better to Iressa.

At one year, almost 25 percent of those on Iressa had continued without a recurrence, compared with nearly 7 percent in the other group.

“Overall, patients who got gefitinib [Iressa] had a longer time from the start of treatment to the worsening of disease,” Simon said. “And it appeared that the drug’s benefit was primarily seen in patients with EGFR mutations.”

Overall survival, however, did not differ between the two groups, probably because many people started the other type of treatment after they had relapsed on the first treatment, Simon said.

The study was funded by AstraZeneca, which makes Iressa.

“This basically confirmed what we have thought, that in selected populations [light smokers or those who never smoked], those testing positive for EGFR mutations will do much better in progression-free survival than if you put the patient on chemo,” Santos said.

“For the first time in a selected population, you have a drug which can compete with systemic chemotherapy,” he said. “There is a pill that matches systemic chemotherapy.”