When Less Means Better

When Less Means Better

Matthew Mouawad Seeks for a Way to Reduce Treatment Times

“How long will my treatment last?” Physicians frequently hear this question from breast cancer patients. A treatment plan may include several steps such as surgery, chemotherapy, radiation, and hormonal and targeted therapy. The availability of many life-saving options brings hope and excitement to patients’ lives; however, anti-cancer treatment takes a long time and may cause multiple side-effects.

“The up-to-date approach to treating breast cancer is to provide patients with effective therapy and at the same time to find opportunities to minimize the physical and emotional burden on patients,” says Matthew Mouawad, a PhD candidate in the Department of Medical Biophysics at Western University.

Matthew Mouawad BCSC Funded ResearcherMatthew works under the supervision of Dr. Stewart Gaede at the London Regional Cancer Program and Dr. Neil Gelman at Lawson Imaging. His work is focused on finding a way to reduce treatment time as well as assess how effective treatment was for patient with early stage breast cancer. Most of these patients can choose between a mastectomy and breast conserving therapies where only the affected tissue is removed. This type of surgery is known as a lumpectomy and is always combined with radiation treatment to reduce the chance of cancer recurrence.

According to the current treatment protocols, breast-conserving therapy involves 5 weeks of external radiotherapy. “It is obviously too long and may be exhausting for patients, especially for the elderly or immobile ones or for those who live far from the cancer centres,” stresses Matthew. “We consider treating these patients with a single dose of radiation before surgery, and this will shorten the total treatment time.”

Matthew is involved in a clinical trial to investigate this new treatment technique. He has used imaging to assess how tumours respond to radiotherapy. Some years ago, St. Joseph’s Hospital in London, ON installed Canada’s first whole-body PET/MRI scanner, and Matthew is now working with it in his research. “This is a novel hybrid imaging technique which combines magnetic resonance imaging (MRI) and positron emission tomography (PET) and offers significant advantages,” explains Matthew. “Using PET/MRI helps us make sure that we have treated our patients appropriately.”

Since the trial headed by Drs. Brackstone, Lock and Yaremko has started, Matthew and his colleagues have been able to observe patients’ responses to the radiation therapy. “My role is in imaging analysis. We are trying to investigate how radiation may affect tissue properties and how we can use the changes in tissue properties to predict how the patient is responding to treatment. This will allow us to provide adaptive therapy specific to the patients’ needs using non-invasive imaging rather than needed the surgically excised tissue,” says Matthew.

“We all understand that surgery is an invasive procedure. Ideally, our research will help remove that invasive aspect of treating early breast cancer. Hopefully we can reduce treatment time to just a few sessions of radiotherapy for these early stage breast cancer patients, and they will be done. They won’t need to go through surgery to remove the tumor from the body. This will increase the cosmetic outcome and improve the quality of life for patients.”

Recently, the trial has been slightly changed because the research team intends to investigate the effect of one session of treatment and, alternatively, three sessions. “We will deliver a smaller dose of radiation over three fractions instead of a more intensive single session of treatment. Researchers hypothesize that the immune system will become primed to attack the tumor. This will help treat patients more efficiently.” As a part of his research, Matthew has also focused on how to reduce the amount of the contrast agent that is used to visualize the tumor in the images to minimize the side effects of radiotherapy.

“Assessing tumour response to these high doses of radiotherapy is fairly recent and there is increasing interest in using it for low risk breast cancer patients. Many of the techniques that we are applying have been used previously, but not in this context. How to translate that knowledge to this setting is what I find the most challenging, but also inspiring in my work.”

Support researchers like Matthew Mouawad and others by considering a donation to the Breast Cancer Society of Canada. Find out how you can help fund life-saving research, visit bcsc.ca/donate

Matthew Mouawad’s story was transcribed from interviews conducted by BCSC volunteer Natalia Mukhina – Health journalist, reporter and cancer research advocate

Natalia Mukhina, MA in Health Studies, is a health journalist, reporter and cancer research advocate with a special focus on breast cancer. She is blogging on the up-to-date diagnostic and treatment opportunities, pharmaceutical developments, clinical trials, research methods, and medical advancements in breast cancer. Natalia participated in numerous breast cancer conferences including 18th Patient Advocate Program at 38th San Antonio Breast Cancer Symposium. She is a member of The Association of Health Care Journalists.

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