Cheaper and better breast cancer radiotherapy often possible

A new form of combined radiotherapy offers significant advantages to breast cancer patients, since healthy tissue and at-risk organs such as the heart and the lungs will receive a lower radiation dose. This discovery was made by UMCG researcher Hans Paul van der Laan. The new treatment also appears to be cheaper than the standard therapy. Since its development, this combined radiotherapy has been introduced in many Dutch hospitals. Van der Laan will be awarded a PhD by the University of Groningen on 3 March.

Until recently, most breast cancer patients who received radiotherapy were given a treatment consisting of a 25-day programme in which the entire breast was irradiated with an 8-day follow-up during which part of the breast – the region operated on – received an additional dose. Van der Laan discovered that replacing these separate programmes with one integrated programme has positive effects. During this single 28-day programme, both the entire breast and the operation area are irradiated simultaneously with different doses of radiation (SIB – simultaneous integrated boost).

Fewer sessions required

The PhD researcher has shown that the healthy tissues and organs are less affected when SIB is applied. He also showed that SIB requires fewer sessions for the same result. The programme thus takes one week less and costs are lower. The combined therapy described by Van der Laan is increasingly used all over the world. Around half the patients in the Netherlands are now treated according to this method.

Expensive treatments are not always better

Van der Laan also investigated which breast cancer patients benefit from a radiation regimen that requires expensive computer equipment (intensity-modulated radiotherapy or IMRT). Two patient groups appear to benefit – those with relatively large operation areas and those with the heart close to the irradiated area. In other cases, this more expensive treatment is not necessarily better than the standard three-dimensional radiotherapy, Van der Laan concluded. By means of a CT scan, hospitals can decide with therapy is the most suitable for individual patients.

Limiting risks

To limit the risks to patients, Van der Laan asserts, the composition of the radiation beams is a critical factor, certainly when the area to be irradiated is large, as is the case when the lymph nodes must be included. Van der Laan’s research has shown that a combination of normal X-rays and electrons may be effective in those cases. Finally, the researcher advocates good consultation between all parties involved – surgeons, pathologists and radiotherapists. If they work as a team, surgery and radiotherapy can be coordinated better.

Curriculum Vitae

Hans Paul van der Laan (Groningen, 1970) has worked as a radiotherapy technician at the UMCG since 1996. He conducted his PhD research in the department of Radiotherapy of the UMCG. His research was supervised by Prof. J.A. Langendijk. After having received his PhD, Van der Laan will start working as researcher in the department of Radiotherapy. His thesis is entitled ‘Optimising CT guided radiotherapy for breast cancer’.

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