Switching order of breast cancer treatment could lower the need for multiple surgeries, study finds

A study suggests that for some breast cancer patients, something as simple as switching up which treatment comes first - giving radiation before doing surgery - can dramatically improve a patient's quality of life and can reduce the need of multiple surgeries.

The study, published Friday in JAMA Network Open, was preliminary, but experts say if the results hold up on larger studies it could one day lead to updated treatment guidelines that make life easier for breast cancer patients.

"The findings are not only promising but also highly significant, marking a potential paradigm shift," said Dr. Roberto Diaz, a Radiation Oncologist with a focus on breast cancer from the Moffitt Cancer Center in Tampa, Florida.

Breast cancer treatment varies from person to person. Some aggressive breast cancers are initially treated with surgery to remove the cancerous breast, a procedure called mastectomy, followed by radiation. This is called "post-mastectomy radiation" and it kills the remaining cancer cells.

Due to the risk of complications, patients must wait six to 12 months after radiation treatment before getting cosmetic reconstruction of the breast tissue. The implant surgery must be delayed to avoid deformities that may occur due to radiation.

The current treatment approach has various challenges for patients with breast cancer.

"Women requiring post-mastectomy radiation, particularly if they desire reconstruction, undergo multiple surgeries… and have poor quality of life while waiting for reconstruction. Despite efforts to minimize long-term toxicity from radiation, cosmetic outcomes are often suboptimal with deformities of the tissue around the implant" said Dr. Ronica Nanda, a Radiation Oncologist at the Moffitt Cancer Center in Tampa, Florida.

Dr. Mark V. Schaverien, faculty in the Department of Plastic Surgery at the University of Texas MD Anderson Cancer Center, conducted a phase two clinical trial of 48 patients with breast cancer that required radiation and desired breast reconstruction and investigated the effects of changing the order of treatment. These patients underwent "pre-mastectomy radiotherapy," or radiation first, followed by surgery to remove the cancerous tissue. Completed radiation meant patients could get reconstruction surgery at the same time without risking implant deformities. This order was found to be feasible and did not result in complications.

Experts are optimistic about the potential benefits these findings suggest. Dr. Clary Evans, Radiation Oncologist from Northwell Health, in New Hyde Park, New York, said that this new treatment sequence has the potential for "better overall cosmetic outcomes, reduced numbers of surgical procedures, and reduced overall treatment time for some patients."

However, experts also caution that this study is small and there is still more research that needs to be done before knowing how this will change current treatment.

"We eagerly await the results of their upcoming Phase 3 study for further validation and insights into long-term outcomes," said Dr. Diaz.

A larger clinical trial with 126 patients started in April 2023 and is ongoing.

Dr. Ashley Yoo, MD is a member of the ABC Medical News Unit and an Internal Medicine Resident at George Washington University Hospital in Washington, DC.

Dr. Camry Kelly, DO is a member of the ABC Medical News Unit and is Chief Resident at Mayo Clinic Family Medicine Residency Program in Rochester, Minnesota.