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Expert Point of View: Virginia Kaklamani, MD and Wendy A. Woodward, MD


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Virginia Kaklamani, MD

Virginia Kaklamani, MD

At a press conference held during the 2018 San Antonio Breast Cancer Symposium, moderator Virginia Kaklamani, MD, said that partial-breast irradiation is underutilized in the United States for women with breast cancer. Dr. Kaklamani is Professor of Medicine at The University of Texas at San Antonio and leader of the Breast Cancer Program at The University of Texas MD Anderson Cancer Center, Houston.

“In the United States, a majority of women [with breast cancer] receive whole-breast irradiation. Partial-breast irradiation is not as commonly used in the United States, and shorter courses of radiation are generally not adopted. Partial-breast irradiation is not used as much as it should be. This study, along with the Z-11 study, should provide reassurance that partial-breast irradiation is safe and effective. The medical community needs to improve the uptake of partial-breast irradiation, and women should be asking for it. Many women with breast cancer believe that more therapy is better. Physicians and patients should not be as afraid as they are that partial-breast irradiation won’t be as effective as whole-breast irradiation,” she said.

In the American Society for Radiation Oncology guidelines, partial-breast irradiation is listed as an option for selected patients. Dr. -Kaklamani said they are using partial-breast irradiation at her institution in accordance with the guidelines (ie, women at low risk, aged 50 years and older, with clear surgical margins and/or ductal carcinoma in situ).

Treatment Advances

Formal discussant of the NSABP B-39/RTOG 0413 trial, Wendy A. Woodward, MD, of The University of Texas MD Anderson Cancer Center, Houston, said that in general, advances in techniques and technology have made radiotherapy significantly less toxic

Wendy A. Woodward, MD

Wendy A. Woodward, MD

and a more attractive option for women with breast cancer. She said that further studies of accelerated partial-breast irradiation should evaluate alternative schedules and techniques to improve therapeutic and cosmetic outcomes.

“Updates of consensus guidelines for accelerated partial-breast irradiation and further integration of these results with published randomized trials using alternative techniques and regimens without significant toxicity are warranted,” she concluded. 

DISCLOSURE: Dr. Kaklamani has received honoraria for speaking from Pfizer, Celgene, Genentech, Genomic Health, Puma, Eisai, and Novartis; is a consultant for Amgen, Eisai, Puma, Celldex Therapeutics, AstraZeneca, and Athenex; and has received research funding from Eisai. Dr. Woodward reported no conflicts of interest.


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Partial-breast irradiation delivered over 5 to 10 days did not meet noninferiority criteria compared with whole-breast irradiation given over 5 to 7 weeks, according to 10-year results of the large NRG (NSABP B-39/RTOG 0413) trial presented at the 2018 San Antonio Breast Cancer Symposium.1 However, ...

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