NORMAL - More precise and intense radiation, a test that assesses the likelihood that cancer will recur and a study to determine whether some women can avoid chemotherapy are among advances for breast cancer patients at the Community Cancer Center.

Respiratory gating

A challenge of radiating the left breast is the heart can get in the way, said Dr. Don Stacy, radiation oncologist with Cancer Care Associates at the cancer center.

"There is a 5 percent risk of heart damage," which could show up years after radiation treatments, Stacy said.

Respiratory gating is an attempt to avoid zapping the heart by delivering radiation when the heart is furthest away.

"Without gating, as you breathe in and out, the (radiation) beam is on the whole time," Stacy said. "With respiratory gating, the beam is on only during certain times - when we want it on."

The downside is that a radiation treatment may last two to four minutes rather than one minute, Stacy said. The upside is less radiation to the heart and more radiation where it's needed attacking the tumor.

Respiratory gating doesn't work for patients with erratic breathing patterns but that's a small percentage of patients.

"It's been going very well," Stacy said.

"We used to treat to a broader field," said radiation therapist Rae Anne Robertson. "Now we target things to get the most radiation to the tumor without radiation to the other healthy tissue."

Partial breast radiation

Traditional radiation is given for 6 ½ weeks. The Cancer Center is part of a study to determine whether more intense, precise radiation increases the likelihood of cancer not recurring.

Partial breast radiation involves focusing radiation on the area of the breast where the tumor had been. "Eighty to 90 percent of the time, when cancer comes back, it comes back there," Stacy said.

Partial breast radiation also means 10 treatments over five days - two treatments a day, six hours apart. Ten to 15 minutes are spent at the Cancer Center each time. The amount of radiation per treatment is higher than with traditional radiation, Stacy said.

Some large cancer centers studied partial breast radiation for five years and concluded that it was safe and there was less than a 10 percent chance of breast cancer returning, Stacy said.

"The initial results look good," he said.

The current study - which involves the Community Cancer Center - is comparing partial breast radiation to traditional radiation to determine which is more effective.

Women are eligible for the study if they are less than 50 years old or if they are more than 50, have one to three lymph nodes involved or are hormone receptor negative.

Patients like partial breast radiation because they're through with radiation in a week, Stacy said. Side effects include fatigue and sunburn but all radiation patients get that, he said.

Oncotype DX testing/TAILORx

Oncotype DX is a lab test that assesses the likelihood of breast cancer recurring and helps determine the benefit of chemotherapy.

Oncotype looked at errors in gene codes that resulted in breast cancer and found 16 genes that commonly mutated, explained Dr. John Migas, a medical oncologist with Mid Illinois Hematology & Oncology Associates, and Dr. Patrick Gomez, a medical oncologist with Illinois Cancer Care. When a patient's tumor is removed, it is analyzed to determine the number of genetic errors that caused the cancer, they said. Those 16 genes and five control genes are analyzed in patients and the more that are damaged, the higher the score.

The study is to determine whether these scores accurately predict the likelihood of cancer returning, Migas said. Until Oncotype, doctors used a tumor's size, its aggressiveness and the number of lymph nodes affected to determine the likelihood of recurrence.

"Oncotype is more accurate and allows us to give patients the best treatment," Migas said. "We don't over-treat and we don't under-treat."

"Patients feel better about their treatment based on Oncotype," Gomez said. "It's a tool that seems to be consistently accurate."

Patients considered at low risk for recurrence generally are recommended for a hormone pill. In the past, those patients may also have been given chemo - more aggressive treatment that often results in side effects including vomiting and hair loss.

Patients at high risk are given a hormone pill as well as chemo, Migas said.

About half of cancer center patients have gotten Oncotype testing. Initially, it was approved only for patients whose lymph nodes were not affected. Now the testing will be expanded to lymph node-positive patients, Migas said.

Intermediate risk patients all get chemotherapy now because doctors don't want to under-treat, Migas said. A new clinical trial called TAILORx is studying whether intermediate risk patients can get a hormone pill and avoid chemotherapy.

"We are continually trying to better treat our patients," Migas said. "We have more tools to offer, better treatment strategies and more medicines to enhance their survival."