2024-02-09 06:47:08
by Vera Martinella
New international recommendations (coordinated by Italian specialists) answer previously open questions and indicate the way forward: whether, how, when and how much to integrate radiation depending on the individual case
With more than 55 thousand new cases diagnosed every year, breast cancer is the most frequent cancer in Italy. In addition to surgery, radiotherapy sessions are a cornerstone of treatment due to their undoubted usefulness in reducing the risk of both local recurrences (post-surgery radiation helps to better “clean up” the area affected by the tumor) and distant metastases. . In a significant number of patients, radiotherapy is combined with drugs, both old and new.
«The combined use of radiotherapy and chemotherapy is the standard for many types of breast cancer: it has been widely exploited over the years, we know its effectiveness and possible side effects – underlines Icro Meattini, Associate Professor of Radiotherapy Oncology at the University of Florence and director of the Breast Unit of the Careggi University Hospital. The same goes for numerous medicines (such as those with molecular targets or target therapies) that have gradually been added to the oncologists’ armamentarium. But in recent years many innovative drugs have arrived (including immunotherapeutics or conjugated antibodies, for example) and their use together with radiation is not always clear.”
Thus was born document just published in the scientific journal The Lancet Oncology which answers specialists’ daily questions: whether, how, when and how much, depending on the specific pharmacological therapy, radiotherapy can be effectively integrated into the treatment process.
Radiotherapy for 70% of cancer patients
As the statistics presented at the last congress of the Italian Association of Radiotherapy and Clinical Oncology (Airo) indicate, radiotherapy treatment is prescribed to over 70% of cancer patients, alone or associated with surgery, chemotherapy, hormone therapy, immunotherapy and the cases in which it is the first choice are increasing. And it is estimated that the healing of tumors (both solid and haematological) is due to surgery in 46.5% of cases, radiotherapy in 42% and chemotherapy in 11.5%.
In some cases, radiotherapy treatment alone can completely eliminate the tumor and radiation can be very effective even in so-called oligometastatic patients, i.e. those with few metastases. «Radiation therapy (there are different types) is an irreplaceable weapon and is also capable of healing a tumor patient, alone or in combination with scalpels and drugs – underlines Lorenzo Livi, director of the Radiotherapy Oncology Unit, Department of Oncology of the Careggi University Hospital —. Or extend his life. Or even improve it, for example by keeping the pain from bone metastases at bay. They are no longer “toxic” as they once were, but increasingly precise, aimed at the target to be hit, sparing healthy tissue.”
The new recommendations
How to exploit the combined effectiveness of radiotherapy and drugs in the treatment of breast cancer? They answer this question the new recommendations, sponsored by the European Society of Radiation Oncology (Estro) and the result of the work of major international experts coordinated by the radiotherapists of Careggi, also members of the Oncology Radiotherapy Foundation, which for over thirty years has been committed to promoting scientific research in the radiotherapy field and improving care for people affected by cancer.
«It is the first international document on the safety and effectiveness of the association of new drugs with radiotherapy in the treatment of breast cancer, both in the initial and advanced stages – explains Meattini -. Although the synergistic approach of radiation therapy with new drugs often constitutes a winning combination for the treatment of this as well as other oncological pathologies, scientific evidence on large-scale trials was limited at the time. With this consensus document we fill various gaps or offer practical clinical guidance, with tables.”
In the last decade, oncology radiotherapy has made significant progress: it is increasingly precise, effective and with fewer side effects. «Many prejudices and false myths persist, but they are now old and outdated – concludes Livi -. Just like many innovative drugs, radiation today can be personalized to the individual patient, thanks to techniques and machinery that have evolved over time, with reduced dosages and a lower number of sessions.”
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February 9, 2024 (modified February 9, 2024 | 07:47)
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