Researchers at the UPMC Hillman Cancer Center are pioneering a new method for treating early-stage breast cancer by administering radiation therapy prior to surgery. This innovative clinical trial is spearheaded by Dr. Parul Barry, a radiation oncologist, and Dr. Ravi Patel, a physician-scientist at the University of Pittsburgh. Their goal is to use targeted doses of radiation to shrink tumors before surgical removal, a shift from the traditional approach of post-surgery radiation.
The clinical trial aims to address several issues associated with conventional treatment methods. Traditionally, patients undergo three to seven weeks of daily radiation following surgery. Dr. Barry noted that this extended treatment schedule often discourages many women, especially those balancing work or caregiving duties, leading to approximately one-third of breast cancer patients in the United States not completing their radiation therapy. In contrast, the Hillman trial reduces the overall treatment duration to about three weeks by delivering just five radiation treatments over the course of one week prior to surgery.
“With just five treatments and relatively low toxicity, you’re mitigating some of the reasons why people may skip radiation,” Dr. Barry explained. “Patients are completing the treatment and tolerating it well.”
Dr. Patel’s research focuses on how radiation might stimulate the body’s immune system to better combat cancer cells. He explained, “When we irradiate the tumor, we can cause some of those cancer cells to die and release what we call cancer neoantigens that your immune system can process. We can potentially mount an immune response against cancer if we give the radiation upfront rather than after surgery.”
The trial is distinguished by the close collaboration between clinicians and researchers at Hillman. Blood samples from participants are sent immediately to Dr. Patel’s lab for analysis of immune markers and molecular responses to the treatment. This approach could help identify which patients benefit most from this method and may even allow some patients to forgo surgery altogether in the future.
“This is truly a bench-to-bedside trial,” Dr. Barry stated. “That’s the only way we’ll actually be able to move precision therapy forward.”
Dr. Margaret Quinn Rosenzweig, an oncology nurse-researcher at the University of Pittsburgh who is not involved in this trial, emphasized how crucial physician endorsement is in encouraging patient participation in clinical trials. Patients often seek reassurance from their doctors about the benefits of participating, asking whether the doctor would recommend it for their own family members.
Rosenzweig pointed out that trials like Barry’s are notable for addressing real-world clinical questions. “It’s a brave clinician who’s questioning their own practice,” she remarked. “It’s truly a scientific endeavor to assess whether we are doing everything we should be or if changes are necessary.”
The concept of delivering radiation before surgery is not new; it has become standard practice in treating colorectal cancer and is increasingly being explored in other types of cancer. The rationale is that shrinking tumors can decrease the need for more invasive procedures and help maintain organ function.
As for early results from the trial, Dr. Barry shared promising observations. “Overall, the breasts look almost as normal as they did before surgery,” she noted. “Patients are progressing through the radiation well and healing effectively, with very low toxicity levels.”
This innovative approach could enable more patients to retain their breasts while still achieving effective treatment outcomes. Dr. Barry highlighted the psychosocial importance of preserving breast tissue for many women, stating, “Radiation allows for cancer cure without significant disfigurement.”
Currently, the trial is enrolling patients diagnosed with stage 1 hormone-sensitive breast cancers, with plans to expand to include higher-risk cancers and explore combinations of radiation with chemotherapy or hormone therapy in the future.
