Analysis: How UCL clinicians invented a new way of treating breast cancer

As a large trial confirms the effectiveness of single-dose radiotherapy in treating breast cancer, Principle Investigator, Professor Jayant Vaidya (UCL Surgery & Interventional Science), describes how he and colleagues developed a new therapy which challenged convention. Breast cancer patients with early disease have traditionally had just two options: lumpectomy (breast conservation), which invariably has to be followed by whole breast radiotherapy, or a mastectomy. Unfortunately, for some patients, there hasn't really been a choice since postoperative radiotherapy requires repeated daily hospital visits for up to six weeks. If it wasn't possible for the patient to commit to this prolonged treatment then mastectomy was the only option, drastically altering their quality of life. In the 1990s I was a newly qualified surgical oncologist in India, and I faced this problem on a daily basis. I was also studying the pathological distribution of breast cancer in mastectomy specimens. We found that in addition to the main cancer, multiple foci are often present scattered widely within the breast. This didn't fit with the fact that local recurrence, if it occurred at all, was almost always limited to an area close to the original tumour. When we published this paper on multicentricity, we questioned whether these other foci really needed to be treated at all. Could we instead give radiotherapy just to the tumour bed during the cancer operation, perhaps sidestepping the need for whole breast radiotherapy?