ROCHESTER, Minn. ― Radiation therapy for breast cancer can be grueling and disruptive, stretching out for as long as five to seven weeks, and often requiring extended time off from work or away from home. But research over the past decade, as well as new technology and innovations at Mayo Clinic, has led to treatment alternatives that are shorter, more targeted and just as effective.

For one example, over the past five years, Mayo Clinic breast cancer experts have been evaluating a short course of partial breast irradiation (PBI), a type of radiation therapy given after lumpectomy only to the area of the breast from which the tumor was removed. It has long been established that lumpectomy plus whole-breast irradiation over an extended period of weeks achieves results comparable to mastectomy in early-stage breast cancer. Recent studies, however, have shown that certain patients who have undergone lumpectomy can have the same excellent outcomes with partial breast irradiation administered over a three-day period.

"This is a remarkable and welcome change for many patients," says Robert Mutter, M.D., a physician who leads Mayo Clinic's Breast Cancer Radiation Oncology Group. "When I was in training, many of these patients were routinely treated with five to six weeks of daily radiotherapy. At Mayo Clinic, patients now have opportunities to complete radiotherapy in as few as three days with markedly less exposure to normal tissue."

This three-day accelerated treatment protocol is one of several that Mayo offers for breast cancer patients, and these more targeted treatments can be especially helpful and valuable during the COVID-19 pandemic. Though the accelerated treatment protocols long predate the pandemic, many patients may not be aware of how options have changed for treating breast cancer. October is Breast Cancer Awareness Month, when attention is drawn nationally to educating the public about the most common type of cancer reported annually in the U.S.

Accelerated treatments can greatly reduce the number of trips to the hospital or clinic, which reduces risk for health care workers and patients.

"An important goal of our program since long before the pandemic began has been to limit the number of nontherapeutic trips to the hospital and clinic for our early-stage breast cancer patients," says Tina Hieken, M.D., a Mayo Clinic surgical oncologist who specializes in breast cancer. "One aspect of this is to limit the number of days needed for radiation treatments without compromising disease control and safety. Our expertise in short-course radiotherapy has enabled us to deliver lifesaving radiotherapy for breast cancer patients without significant treatment delays during the COVID-19 pandemic."

Elderly patients and individuals with significant health issues or comorbidities are at greater risk of COVID-19 infection and illness. "Our entire team, consisting of therapists, dosimetrists, physicists, nurses, nurse practitioners, physician assistants, physicians and support staff, takes enormous pride in the work we've been doing to deliver safe radiotherapy care through the pandemic," Dr. Mutter says.

Patients have access to advanced technology, including proton beam therapy, catheter-based brachytherapy, and other tissue-sparing techniques that may not be available at other centers. The Mayo Clinic Proton Beam Therapy Program uses pencil beam scanning, which Mayo investigators have shown reduces radiation exposure to healthy tissue.

Mayo Clinic has been evaluating the three-day partial breast irradiation protocol for over five years, including with proton therapy. "Proton beam PBI is attractive for selected early-stage breast cancer patients, as it nearly eliminates all exposure to the heart and lungs, and also reduces the volume of normal nontarget breast tissue exposed, compared with conventional X-rays," Dr. Mutter says.

An additional novel approach to partial breast irradiation that's available at Mayo Clinic in Rochester is internal radiation, or brachytherapy, which uses a catheter that is placed at the time of surgical procedure. This reduces the waiting time between surgery and the start of radiation treatments. At Mayo, brachytherapy begins just two days after surgery, and when the three-day partial breast irradiation regimen is used, the entire treatment, surgery and radiation can be completed in a single week. Dr. Hieken says that this approach is possible because of the close collaboration between the breast surgical oncology and radiation oncology teams in conjunction with Mayo's intraoperative frozen section pathology practice.

Among other accelerated treatment protocols used to treat breast cancer at Mayo is a recently adopted five-treatment whole-breast radiotherapy regimen, now a standard treatment option at Mayo for patients with early-stage breast cancer patients who may not be candidates for partial breast irradiation due to the presence of one or more adverse disease features. "Based on Mayo Clinic's own investigations as well as international research, the five-treatment whole-breast radiotherapy regimen produces similar disease control and impact on normal tissue as 15 treatments over three weeks, the previous standard," says Dr. Carlos Vargas, a radiation oncologist who has led Mayo's five-treatment whole-breast irradiation clinical studies.

These and other short-course protocols have been investigated for more than five years at Mayo Clinic in Arizona, Florida and Minnesota, and many of these options are available at Mayo Clinic Health System locations. Proton beam therapy has been available at Mayo Clinic in Arizona and Rochester since 2015.

Accelerated radiotherapy protocols are being investigated for other types of cancer, as well, but Dr. Vargas says it appears patients with breast cancer may be particularly appropriate for short-course radiotherapy regimens. "It appears that breast cancer is more sensitive to radiotherapy that is condensed into larger treatments," he says. "Thus, we can reduce the total dose administered to breast cancer patients while achieving the same excellent disease control outcomes with the same or lesser impact on normal tissue."

While some of the protocols are now considered standard of care because they've been investigated over a longer period of time and have been subject to large, multi-institutional randomized trials, others are unique offerings at Mayo Clinic. "Patients have not been observed for as long after certain short-course regimens, so we will need to continue to follow patient outcomes over the long term to optimize all our treatment approaches," Dr. Mutter says. "But the response from patients and the reported outcome data have been positive and encouraging."

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and Mayo Clinic Facts for more information about Mayo.

Media contact:

• Joe Dangor, Mayo Clinic Public Affairs, newsbureau@mayo.edu

The post Expert Alert: Accelerated breast cancer treatments at Mayo Clinic provide more options for patients during pandemic appeared first on Mayo Clinic News Network.

On the Mayo Clinic Radio program, Dr. Jennifer Martinez-Thompson, a Mayo Clinic neurologist, discusses diagnosis and treatment options for Lou Gehrig's disease, also called amyotrophic lateral sclerosis (ALS). Also on the program, Dr. Molly Jeffery and Dr. W. Michael Hooten share new Mayo Clinic research on trends in opioid use. Dr. Jeffery is the scientific director of Emergency Medicine Research at Mayo Clinic, and Dr. Hooten is a Mayo Clinic anesthesiologist and pain medicine specialist. And Dr. Paul Brown, a Mayo Clinic radiation oncologist, explains a new radiotherapy approach aimed at preserving cognitive function for some brain tumor patients.

The post Mayo Clinic Radio: ALS / opioid research / new radiotherapy techniques appeared first on Mayo Clinic News Network.

On the Mayo Clinic Radio podcast, Dr. Jennifer Martinez-Thompson, a Mayo Clinic neurologist, discusses diagnosis and treatment options for amyotrophic lateral sclerosis (ALS). Also on the podcast, Dr. Molly Jeffery and Dr. W. Michael Hooten share new Mayo Clinic research on trends in opioid use. Dr. Jeffery is the scientific director of Emergency Medicine Research at Mayo Clinic, and Dr. Hooten is a Mayo Clinic anesthesiologist and pain medicine specialist. And Dr. Paul Brown, a Mayo Clinic radiation oncologist, explains a new radiotherapy approach aimed at preserving cognitive function for some brain tumor patients.

The post #MayoClinicRadio podcast: 1/12/19 appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Jennifer Martinez-Thompson, a Mayo Clinic neurologist, will discuss diagnosis and treatment options for ALS. Also on the program, Dr. Molly Jeffery and Dr. W. Michael Hooten will share new Mayo Clinic research on trends in opioid use. Dr. Jeffery is the scientific director of Emergency Medicine Research at Mayo Clinic, and Dr. Hooten is a Mayo Clinic anesthesiologist and pain medicine specialist. And Dr. Paul Brown, a Mayo Clinic radiation oncologist, will explain a new radiotherapy approach aimed at preserving cognitive function for some brain tumor patients.

Here's your Mayo Clinic Radio podcast.

The post ALS / opioid research / new radiotherapy techniques: Mayo Clinic Radio appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Jennifer Martinez-Thompson, a Mayo Clinic neurologist, will discuss diagnosis and treatment options for ALS. Also on the program, Dr. Molly Jeffery and Dr. W. Michael Hooten will share new Mayo Clinic research on trends in opioid use. Dr. Jeffery is the scientific director of Emergency Medicine Research at Mayo Clinic, and Dr. Hooten is a Mayo Clinic anesthesiologist and pain medicine specialist. And Dr. Paul Brown, a Mayo Clinic radiation oncologist, will explain a new radiotherapy approach aimed at preserving cognitive function for some brain tumor patients.

To hear the program, find an affiliate in your area.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: ALS appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Jennifer Martinez-Thompson, a Mayo Clinic neurologist, will discuss diagnosis and treatment options for ALS. Also on the program, Dr. Molly Jeffery and Dr. W. Michael Hooten will share new Mayo Clinic research on trends in opioid use. Dr. Jeffery is the scientific director of Emergency Medicine Research at Mayo Clinic, and Dr. Hooten is a Mayo Clinic anesthesiologist and pain medicine specialist. And Dr. Paul Brown, a Mayo Clinic radiation oncologist, will explain a new radiotherapy approach aimed at preserving cognitive function for some brain tumor patients.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Use the hashtag #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows or subscribe to the podcast.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

The post Mayo Clinic Radio: ALS / opioid research / new radiotherapy techniques appeared first on Mayo Clinic News Network.

Radiosurgery, not whole-brain radiotherapy should be the standard of care following surgical resection of metastatic brain tumors

Embargoed until Sunday, Sept. 25, at 3:15 p.m. EDT

Radiosurgery to the surgical cavity following surgery to remove metastatic brain tumors is effective in killing residual cancer and results in fewer cognitive problems and better quality of life than whole-brain radiotherapy, according to the results of a phase III, multi-institutional, cooperative group study presented today at the 2016 ASTRO annual meeting.

“This trial confirms radiosurgery to the surgical cavity is a viable treatment and should be one of the standards of care after resection of brain metastases,” says lead author Paul Brown, M.D. a radiation oncologist at Mayo Clinic. “We found no difference in survival whether a patient receives postoperative radiosurgery or whole-brain radiotherapy; however, radiosurgery avoids the cognitive damage caused by whole-brain radiotherapy and other unpleasant side effects, such as hair loss, fatigue and skin redness.” Dr. Brown adds that recovery after radiosurgery is typically shorter than with whole-brain radiotherapy, so patients can restart systemic therapies such as chemotherapy sooner.

Effective treatments for mouth sores caused by radiation therapy

Embargoed until Sunday, Sept. 25, at 3:15 p.m. EDT

Pain from oral mucositis, or mouth sores, in patients receiving radiation therapy for cancers of the head and neck was significantly reduced by an oral rinse of doxepin and an oral rinse containing diphenhydramine, lidocaine and antacids, known as Magic Mouthwash, compared to a placebo. These were the findings of a three-arm, multi-institution, randomized, double blind, placebo-controlled, phase III trial, led by Robert Miller, M.D., a radiation oncologist at Mayo Clinic. Dr. Miller presented his findings at today at the 2016 ASTRO annual meeting.

“We published a study in 2012 showing that an oral rinse of doxepin reduced oral mucositis-related pain, compared to placebo,” says Dr. Miller. “However, there were no large randomized controlled trials studying the potential benefits of Magic Mouthwash.”

Dr. Miller and his colleagues studied 275 patients between November 2014 and May 2016 and found that pain related to oral mucositis was significantly less following both doxepin and Magic Mouthwash rinses versus placebo. They also found that both doxepin and magic mouthwash rinses were well tolerated by patients.

Researchers identify specific sites of prostate cancer recurrence following radiation therapy using C-11 choline positron emission tomography scanning

Embargoed until Tuesday, Sept. 27, at 4:45 p.m. EDT

A team of Mayo Clinic researchers have used C-11 choline positron emission tomography scanning (CholPET) to identify anatomic patterns of prostate cancer recurrence in patients who have a rising prostate-specific antigen level (PSA) after having received radiation therapy to treat their cancer. Researchers found that most recurrences were localized to the pelvis (prostate and or surrounding tissue). Using these data, they were able to generate a tool that estimates the risk of recurrence outside of the pelvis. This information may be an aid in clinical decision -making.

“Management of recurrent prostate cancer after radiation therapy depends on accurately identifying the site of the recurrent disease,” says William Parker, M.D., a urologic oncology resident at Mayo Clinic. “We found that CholPET identified the site of recurrence in 87 percent of patients who had a rising PSA after radiation therapy, most of whom had disease that could potentially benefit from further salvage therapy. Our findings underscore the importance of advanced imaging in tailoring a treatment plan for patients who have a rising PSA following primary radiation therapy.”

C-11 choline positron emission tomography (PET) scanning useful in locating prostate cancer recurrence following surgery and radiation therapy.

Embargoed until Tuesday, Sept. 27 4:45 pm ET

Using C-11 choline positron emission tomography, Mayo Clinic investigators observed very few sites of prostate cancer recurrence within prostate bed of patients who had previously undergone prostatectomy followed by either salvage or adjuvant radiotherapy. This is the finding of a study presented today at the 2016 ASTRO annual meeting by Jaden Evans, M.D., a radiation oncology resident at Mayo Clinic.

“C-11 Choline PET scanning is a useful means of evaluating sites of prostate cancer recurrence following radiation therapy,” says Dr. Evans. "It provides an opportunity to improve our ability to locate disease recurrence and hopefully an earlier stage in disease progression when the burden of disease is lower."

MEDIA CONTACT: Joe Dangor, Mayo Clinic Public Affairs, 507-284 5005, newsbureau@mayo.edu

Researchers studied more than 2800 patients with prostate cancer who were scanned using CholPET between 2008 and 2015. 391 patients had previously received either definitive, adjuvant, salvage or palliative radiotherapy. Of these patients, researchers identified 41 patients who had undergone prostatectomy followed by prostate bed only radiotherapy and who subsequently experienced a biochemical relapse with at least one site of recurrence identified by CholPET.

Researchers examined sites of recurrence with respect to radiation fields and patient anatomy. Researchers noted that the majority of recurrence sites occurred in lymph nodes outside of the previously irradiated field.

“Perhaps our most compelling observation in this cohort was very few in-field sites of recurrence,” says Dr. Evans. “We interpret these findings as evidence that post-prostatectomy radiotherapy is effective.”

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About Mayo Clinic Cancer Center
As a leading institution funded by the National Cancer Institute, the Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call the clinical trial referral office at 1-855-776-0015 (toll-free).

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

The post Mayo Clinic physicians present research findings at 2016 ASTRO Annual Meeting appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Radiation therapy was associated with a lower risk of cancer recurrence in pancreatic cancer surgery patients, making it, like chemotherapy, an important addition to treatment, Mayo Clinic research found. Whether radiotherapy helps patients after pancreatic cancer surgery has been a long-standing question, and the findings suggest that it does, says senior author Christopher Hallemeier, M.D., a radiation oncologist at the Mayo Clinic Cancer Center. The study is published in the American Society for Radiation Oncology’s  International Journal of Radiation Oncology, Biology, Physics.

The researchers studied 458 patients who had pancreatic cancer surgery at Mayo Clinic between March 1987 and January 2011. Of those patients, 378 received chemotherapy and radiation therapy after surgery, and 80 had only chemotherapy after their operations.

Eighty percent of those who received chemotherapy and radiation after surgery had no recurrence of cancer within the area targeted by the radiation, the tumor bed and lymph nodes, within five years after diagnosis. That compared with 68 percent of those who had chemotherapy only following their operations. Additionally, patients who received radiotherapy had longer survival times.

Over the past five years or so, the trend has been toward providing chemotherapy and radiation before surgery in an increasing number of patients with operable pancreatic cancer, Dr. Hallemeier says. He and his colleagues plan research to study the benefit of that, but first wanted to address the longtime question of whether radiation helps after surgery.

“The role of radiation therapy in operable pancreatic cancer has been somewhat controversial. There have been some studies that have shown a benefit and some studies that have not shown a benefit,” Dr. Hallemeier says.

Media contact: Sharon Theimer in Mayo Clinic Public Affairs, 507-284-5005 or newsbureau@mayo.edu

“Our large study suggests that adding radiation treatment in combination with surgery and chemotherapy reduces the rate of cancer recurrence.”

Pancreatic cancer is the fourth-leading cause of cancer death, and it is on the rise. About 50,000 people are diagnosed with pancreatic cancer each year in the U.S., and in about half, the cancer has spread elsewhere in the body, ruling out surgery. Historically, only about 7 percent of pancreatic cancer patients have lived at least five years after diagnosis.

Only about 15 percent of patients have cancer isolated within the pancreas, making them candidates for an operation to remove the tumor. In the other 35 percent, the cancer involves critical blood vessels outside the pancreas; in some cases, especially with chemotherapy and radiation before surgery, operations are complex but possible.

“The black and white, ‘surgery yes or no’ that historically has been the first approach, that’s being blurred. We’re realizing that there are patients in the middle of the spectrum who may be candidates for surgery,” Dr. Hallemeier says. “With tailored approaches to treatment before surgery, for example using chemotherapy first to see how the tumor responds, and then selectively using radiation, I think we can personalize treatment for patients who are most likely to benefit.”

The first author is Kenneth Merrell, M.D., a radiation oncology resident.

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About Mayo Clinic Cancer Center
As a leading institution funded by the National Cancer Institute, Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call 1-855-776-0015 (toll-free).

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

The post Mayo Study: Radiation an Important Addition to Treatment for Pancreatic Cancer Surgery Candidates appeared first on Mayo Clinic News Network.