The study aims to recruit 352 select patients who, instead of radiation treatment, would be followed regularly over a five-year period.
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Thanks to a new clinical trial led by a team at the Jewish General Hospital, select breast cancer patients will be able to avoid radiation therapy and the side effects that come with it.
A first of its kind in Canada, the Rosalie trial will include breast cancer patients who are not at high risk of recurrence, who have undergone chemotherapy and lumpectomies and whose results show no more cancer cells are present.
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Radiation is standard when a lumpectomy is performed to ensure the cancer doesn’t return in other parts of the breast, said Dr. Mark Basik, a surgical oncologist at the JGH. But in some particularly aggressive cases, patients receive chemotherapy before the surgery.
“And what we noticed is when we come to operate them, in many cases there’s nothing left,” Basik said, attributing the results to the improvement of chemotherapy treatments. “They’re getting that good that we can start doing less in terms of local therapy like radiation — and, perhaps, one day, surgery and so on — beginning these kinds of what are called ‘de-escalation trials’ so that we keep the quality of life or don’t harm the quality of life of our patients, precisely because our therapies are becoming more effective.”
Basik and Dr. Thierry Muanza, a senior radiation oncologist at the JGH, said the study was inspired by patients challenging why radiation would be necessary if their tumours were gone.
“It’s sort of the standard, because we were protecting the breast,” Basik said. “But … we thought that was a reasonable question.”
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The study aims to recruit 352 patients across Canada and, potentially, Australia who, instead of radiation treatment, would be followed regularly over a five-year period. Recruitment will span the first four years and treatment would begin as patients join the trial, bringing its total length to about a decade.
In addition to the JGH, the trial will be offered in major centres across Canada, including Quebec City.
Muanza explained some of the side effects of radiation treatment include a skin reaction similar to a sunburn; inflammation of the breast, which can lead to pain, discomfort, trouble using arms and sleeping comfortably; and pain to the ribs behind the breast.
Post-treatment reactions can include inflammation of part of the lung behind the breast, changes to skin texture, and, in rare cases, the development of a tumour in the tissue that received radiation several years later (this occurs in less than two per cent of cases, only in patients over the age of 30), Muanza said.
“Those risks, even though small, can impact the patient’s health, can impact the patient’s quality of life, ability to return to quote-unquote normal life and functional and professional life,” Muanza said. “This is what we can potentially improve in the selected patients who respond completely to the chemotherapy.”
Those who are interested in learning more about the trial can contact the Jewish General Hospital’s breast cancer research group by calling 514-340-8222 ext. 27562 or emailing asmaa.siouda.ccomtl@ssss.gouv.qc.ca.
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