Breast Cancer

Postoperative radiation therapy is essential, as it reduces the risk of local relapse by one-third.

Our specialists have extensive experience in both conventional radiotherapy (whole breast irradiation for six weeks) and partial radiotherapy, with irradiation applied only to the tumor bed for just five days.

It has been demonstrated that, in early-stage breast tumors, performing partial radiotherapy restricted to the high-risk area (tumor bed) produces extremely positive results with a minimum risk of relapse.

Therefore, the Hospital has implemented different breast irradiation techniques:

• Perioperative high-dose brachytherapy: offers patients significant advantages given that, instead of six weeks of treatment, patients can be finished with treatment in just five days; the treatment is carried out at the same time as the surgery to remove the tumor.
  
  We are a leading international center in this technique and the center with the most extensive accredited experience in performing this minimally invasive intraoperative implant for brachytherapy administration during the postoperative period.
  
  After completing the treatment, the catheters are easily removed during clinic hours, with no need for anesthesia.
   
• Perioperative high-dose brachytherapy plus forward-planned external radiotherapy: a combination of radiotherapy treatments is applied for patients with more widespread cancer. First, brachytherapy is administered directly to the area of greatest risk; this is then complemented with external radiotherapy on the entire region of remaining breast tissue.
• Forward-planned external radiotherapy: this radiotherapy technique offers more advantages than conventional radiotherapy techniques. Radiotherapy is administered in a more homogeneous fashion, reducing acute adverse effects. As a result, treatment can be administered in 15 sessions instead of the 25 sessions required for standard treatment.

Chemotherapy may be given as an adjuvant treatment (after breast cancer surgery), as a neoadjuvant treatment (before tumor surgery), and in cases of metastatic disease to control distant tumors.

Adjuvant chemotherapy is used for localized tumors to support local treatments in controlling the disease, with the intention of eradicating circulating tumor cells and micrometastases.

Neoadjuvant chemotherapy aims to start systemic treatment as soon as possible, assessing the tumor’s response to treatment in vivo (to check that the tumor is sensitive to the treatment and that it decreases in size with chemotherapy). It may also be used to try to reduce the tumor size to facilitate conservative surgery, to ensure only the smallest-possible area of breast tissue needs to be removed, or, in some cases, so that tumors can even be operated on in the first instance.

The Hospital has specific protocols in place and vast experience in the administration of chemotherapy during pregnancy.

We currently have a wide range of anticancer chemotherapy drugs for breast cancer.

Selecting the most appropriate chemotherapeutic schedule will depend on the tumor size, lymph node involvement, the existence of distant metastases, previous treatments, the breast cancer tumor subtype (based on the expression of estrogen receptors, progesterone, HER2, etc.), age, comorbidities, the patient’s functional status and the potential toxicity of treatment.

Hormone therapy is the first treatment used specifically for breast cancers and is prescribed for tumors expressing estrogen receptors.

These are the most common tumors, making up 70–80% of breast cancers.

Hormone therapy has been proven to be beneficial, as it reduces the risk of relapse and increases survival in patients with this hormone-sensitive disease.

There are different drugs such as selective estrogen receptor modulators (tamoxifen), aromatase inhibitors (anastrozole, letrozole, exemestane), LHRH analogs (goserelin, triptorelin), estrogen receptor antagonists (fulvestrant) and progestogens (megestrol acetate and medroxyprogesterone).

The ovaries may also be removed (oophorectomy) to decrease the body’s estrogen production. The main determining factor for selecting the most appropriate hormonal treatment for these patients is ovarian functional status. Patients are therefore divided based on their menopause status, their clinical records, and their blood levels of the hormones produced by the ovaries.

During hormone treatment for cancer, patients must be monitored through gynecological examinations (cytology and ultrasound), and their bone mineralization levels (densitometry) and blood cholesterol levels must also be checked.

This hormone therapy is currently being considered for preventive purposes in patients who have not developed breast cancer but who have been diagnosed with precancerous breast lesions (atypical hyperplasia).

The immune system is central in the development and management of tumors. Immunotherapy aims to stimulate or repair the patient’s immune system so the body itself can fight off the cancer.

Vaccines are made from the patient’s own cells, which are used to create a response in their own immune system to fight the tumor. A limited size of the disease and a combination of immunotherapy and chemotherapy make this a good additional treatment option for breast cancer patients with localized disease requiring chemotherapy.

Tolerance is good because vaccines are made using the patient’s own cells, so there is no risk of rejection. It is also an individualized treatment, which can be given in combination with chemotherapy over a long period over the first five years when the disease is more likely to return.

This is not an isolated therapy but rather complements the patient’s standard oncology treatment with a two-year vaccination schedule.

Vaccines are made in the Hospital’s Cell Therapy GMP Laboratory using cells taken from the patient. After processing the cells, antigens specific to the patient’s tumor are obtained from them.

The Hospital has conducted a clinical trial to test the efficacy of using autologous vaccines aimed at reducing breast cancer progression in a specific subgroup of this disease, where tumor cells do not express the HER2 protein. The Hospital is currently offering these vaccines as a compassionate complementary treatment to regular treatment.

We currently have different drugs that act on tumor cells at either the extracellular or intracellular level.

HER2 is a receptor protein existing in some tumors that causes tumors to grow more actively. Some breast tumors overexpress this protein and can be treated with HER2 receptor antagonists. This treatment has proven highly effective in combination with chemotherapy, improving tumor response to treatment and patient survival.

Trastuzumab and lapatinib are currently available on the market, but new drugs are in development, such as pertuzumab and trastuzumab-DM1.

Lastly, antiangiogenic drugs prevent the formation of abnormal blood vessels that provide nutrients to the tumor and promote its growth and metastasis.

Adding bevacizumab to chemotherapy has been shown to delay disease progression in patients with distant metastases.

The Hospital continues to investigate new therapies with the aim of increasing efficacy and reducing toxicity.