Almost immediately after Theresa Greco was diagnosed with breast cancer in March, doctors asked her whether she wanted to participate in a clinical trial. The trial would do high-powered radiation targeted at her tumor prior to surgery, rather than the typical protocol of doing surgery first, then broader radiation.

Greco, of O'Hara, agreed immediately. Her husband had been open to clinical trials during his prostate cancer treatment 20 years ago, and she credits those trials for his survival.

Her results surprised and pleased not only her but the researchers — just five radiation treatments over a period of less than three weeks eliminated her cancer entirely. She still had surgery afterward, as is the standard of care, where doctors also found no cancer.

The whole process was so smooth that she went to work after every radiation treatment and the day after surgery.

"This entire path was just unbelievable," said Greco, 68. "They couldn't have made it any easier."

For Greco's diagnosis of stage 1 invasive ductal carcinoma, the standard procedures is to do surgery first, removing the tumor, and then a broad-based radiation aimed at killing any remaining cancer cells in the surrounding breast tissue. This clinical trial, run by Parul Barry, a radiation oncologist at UPMC Hillman Cancer Center and clinical assistant professor at the University of Pittsburgh, flips that order — doing radiation first and then surgery.

The advantage of starting with radiation, said Barry, is to be able to use stronger radiation at a smaller area.

"When you deliver the radiation with the cancer intact, you're able to target the cancer," she said. "It's a really nice way to deliver high quality, high doses of radiation right at the cancer in just five treatments, rather than after the surgery, where the cancer has been removed and you are kind of guessing where the highest risk areas are."

While the research is not yet at this point, there is a chance that the radiation-first treatment could eventually help some patients avoid surgery, or provide an alternative for patients who cannot or choose not to have surgery.

Image DescriptionRavi Patel, a physician-scientist at UPMC Hillman Cancer Center, is analyzing the data from the trial led by radiation oncologist Parul Barry. (Sebastian Foltz/Post-Gazette)

It's part of a legacy in Pittsburgh of "right-sizing" cancer treatments for each individual patient, providing a level of intervention tailored to specific cancer diagnoses.

In the 1970s, University of Pittsburgh surgeon and scientist Bernard Fisher challenged medical wisdom through studies showing that radical and total mastectomies weren't necessary for women with early breast cancer, whose outcomes could be just as good if a surgeon cut out the cancerous lump, rather than removing the whole breast.

"The idea of breast conservation is really a sentinel and important concept that's really based and developed in Pittsburgh," said Parul. "Previously, women had to have their entire breast removed with a mastectomy, and it was actually women who fought back at that time."

The clinical trial is still ongoing and, while Greco's had a complete response to the radiation therapy, other patients did not have results that were as dramatic.

Ravi Patel, a physician-scientist at UPMC Hillman Cancer Center, is analyzing the data from the trial in his lab to see what kind of patterns he can find on a cellular level in terms of the patients' response to the radiation.

"This is a true bench-to-bedside trial," said Parul. "We drew blood from Theresa. We had a courier take all those samples directly to Dr. Patel's lab, where he houses them for analysis. It goes directly from one building to the next in 10 minutes. That's something that's very unique here."

In the clinical trial, patients do not do further radiation after surgery, though Greco is taking tamoxifen, a hormone therapy that can reduce the risk of breast cancer recurrence.

Greco's cancer was discovered through a routine mammogram, something that she has been diligent about because her mother died of breast cancer.

She remembers her mother's ordeal, when she went through her own course of breast cancer surgery and radiation in the 1980s. Even though her mother didn't have to have a total mastectomy, given Pittsburgh's progressive view on breast cancer surgery at the time, she still had to have a friend of the family who was a nurse come to change her dressings. Greco also remembers her mother's pure exhaustion after doing weeks of daily radiation treatments.

By contrast, Greco felt fine after her relatively few treatments and could barely even see where the surgery had taken place immediately afterwards, thanks to modern surgical techniques.

"There's no scarring, no disfigurement," she said. "You hear these horror stories, and this was just absolutely amazing."

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