Researchers at the UPMC Hillman Cancer Center in Pittsburgh are pioneering a novel approach to treating early-stage breast cancer by administering radiation before surgical intervention. This clinical trial, spearheaded by assistant professors Dr. Parul Barry and Dr. Ravi Patel at the University of Pittsburgh, aims to reduce tumor size through targeted radiation doses, potentially leading to fewer side effects and shorter treatment durations.
Traditionally, patients receive daily radiation for three to seven weeks following surgery. This lengthy schedule has often discouraged women from completing their treatment, especially those managing work or caregiving responsibilities. According to Dr. Barry, approximately one-third of breast cancer patients in the United States do not complete their radiation therapy. In contrast, the Hillman trial offers five radiation sessions over approximately one week before surgery, reducing the total treatment timeline to around three weeks.
“By administering just five treatments with relatively low toxicity, we address some of the reasons patients might skip radiation,” Barry noted. “Patients can progress through their treatment with ease and tolerate it well.”
The trial also investigates how pre-surgical radiation may bolster the body’s immune response against cancer. Dr. Patel explained that irradiating the tumor could result in cancer cells dying and releasing neoantigens. This process could prompt the immune system to target cancer more effectively if radiation is given upfront rather than afterward.
A distinctive feature of this trial is the close collaboration between clinicians and researchers at Hillman. Blood samples from patients are promptly sent to Patel’s lab for analysis of immune markers and molecular responses to treatment. This data could help identify which patients benefit most from this method and potentially allow some to avoid surgery entirely. “This is truly a bench-to-bedside trial,” Barry stated. “It is essential for advancing precision therapy.”
Adding to the trial’s significance, Dr. Margaret Quinn Rosenzweig, an oncology nurse-researcher at the University of Pittsburgh, emphasized the importance of clinician-led research. Patients often seek reassurance from their doctors regarding trial participation, asking, “Is this something you would recommend for me?” Rosenzweig noted that trials like Barry’s emerge from clinicians addressing real questions encountered in daily practice. “It takes courage for clinicians to question their own practices,” she added.
The concept of administering radiation before surgery has gained traction in colorectal cancer treatments and is increasingly being studied in other cancers. This preemptive approach can reduce the necessity for invasive procedures and help preserve the function of organs. Early results from the Hillman trial have been promising. “Overall, the breasts appear almost as normal as they did before surgery,” Barry reported. “Patients are progressing through radiation effectively and healing very well, with minimal toxicity.”
Barry emphasized the psychosocial importance of breast preservation for women. “Radiation can lead to cancer cures without significant disfigurement, allowing more patients to retain their breasts.”
Currently, the trial is enrolling patients diagnosed with stage 1 hormone-sensitive breast cancers. The research team aims to expand their focus to include higher-risk cancers and explore new combinations of radiation with chemotherapy or hormone therapy in future studies.
