Julia S. Wong, MD

Clinical Research in Breast Cancer

The treatment of early-stage breast cancer with conservative surgery and radiation therapy has evolved over the past several years. More attention has been paid to minimizing treatment in order to minimize toxicity. In selected patients with favorable characteristics, axillary surgery (either axillary dissection or sentinel node biopsy) may be omitted, with the intent to include the lower axilla within the standard breast radiation fields. We previously published our retrospective experience with this approach, and are in the process of reporting our prospective experience.Effect of radiation therapy on breast reconstruction.More breast cancer patients are being considered for postmastectomy radiation therapy, given the recent data suggesting a benefit in patients with positive lymph nodes. In addition, plastic surgical technique has continued to improve over the years, and more patients are electing reconstructive procedures - either simultaneous with the mastectomy or afterwards. However, radiation therapy increases the risk of complications and may alter the ultimate cosmetic result. We are reporting our retrospective experience with breast reconstruction and radiation therapy and plan to explore this issue further in a prospective study.Ductal carcinoma in situ.The management of limited ductal carcinoma in situ (DCIS) is controversial. Researchers are interested in trying to define a subgroup of patients who might be managed safely with excision alone, rather than the standard of excision plus radiation therapy. Our prospective trial closed prematurely due to an unacceptably high rate of local recurrence in carefully selected patients with ostensibly favorable DCIS. We are considering exploring the role of hormonal therapy and concurrent radiation therapy for limited DCIS.In summary, our main focus is clinical research in breast cancer over a broad range of topics. These projects aim to improve breast cancer treatment by optimizing outcomes with respect to tumor control while minimizing the toxicity of radiotherapy.