Optimal Therapy for Breast Cancer
Our research centers on the treatment of breast cancer, with a focus on the optimal integration of systemic therapy and surgery with radiation. In one randomized study, we compared the sequencing of radiation therapy and chemotherapy in women with early-stage disease following breast conservation. In another study, we examined the concurrent use of chemotherapy and radiation in (1) patients with advanced breast cancer to evaluate the toxicity of concurrent radiation and the taxanes and (2) patients with early-stage disease to examine the efficacy of concurrent radiation with cyclophosphamide, methotrexate, and 5 fluorouracil (CMF) chemotherapy. Because of the proven efficacy of trastuzumab in the adjuvant treatment of breast cancer, we plan to study the potential impact of radiation therapy on the long-term cardiac toxicity of trastuzumab.Dana-Farber/Brigham and Women's Hospital is also actively investigating the use of preoperative systemic therapy in operable breast cancer. We are interested in patterns of local or regional recurrences following preoperative chemotherapy. Recently, we received funding to study patterns of recurrence in a uniform group of women with HER2-positive tumors treated with preoperative Herceptin-based therapy. In other research, our group has focused on minimizing radiation therapy in women with low-risk disease. In collaboration with Phillip Devlin, we launched a pilot study of MammoSite partial breast irradiation. This study will limit the radiation exposure to normal tissues in carefully selected patients and improve access to breast conservation. Currently, we are also studying the feasibility and toxicity of treatment, although future studies of partial-breast irradiation will focus on treatment efficacy. Ultimately, randomized trials comparing partial breast irradiation with conventional whole breast radiation will be necessary to determine the utility of this approach.