Surgery is the cornerstone of treatment in patients with localized breast cancer. However, non-surgical treatments have the potential to reduce overall treatment-related toxicity and improve breast preservation while achieving comparable disease control. Stereotactic ablative radiation therapy (SABR) is an advanced treatment modality that achieves cancer controls rates >90% with minimum toxicity. Here, we propose a clinical trial where early stage Estrogen Receptor-positive breast cancer patients undergo preoperative SABR, evaluation of lymph node involvement with cancer via a non-surgical approach called microbubble contrast-enhanced ultrasound and evaluation of response to SABR using...

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Surgery is the cornerstone of treatment in patients with localized breast cancer. However, non-surgical treatments have the potential to reduce overall treatment-related toxicity and improve breast preservation while achieving comparable disease control. Stereotactic ablative radiation therapy (SABR) is an advanced treatment modality that achieves cancer controls rates >90% with minimum toxicity. Here, we propose a clinical trial where early stage Estrogen Receptor-positive breast cancer patients undergo preoperative SABR, evaluation of lymph node involvement with cancer via a non-surgical approach called microbubble contrast-enhanced ultrasound and evaluation of response to SABR using optoacoustic ultrasound imaging. The ablative radiation treatment is designed to both eliminate visible disease (typically addressed with surgery) as well as surrounding invisible microscopic disease (typically addressed with breast radiation after surgery). 9 months after receiving SABR, patients will undergo standard-of-care lumpectomy and lymph node mapping. The agreement between non-surgical versussurgical sentinel lymph node mapping and between treatment response determined by pathologist versus imaging will be established. Findings from this study will allow designing new clinical trials in early stage breast cancer patients comparing SABR-based non-surgical approaches with standard-of-care surgical treatment. Thus, we propose a bold and revolutionary approach for non-surgical management of patients with early stage breast cancer. If successful, it will provide an alternative option of replacing the current standard of care treatment of [lumpectomy surgery+sentinel lymph node mapping+1-4 weeks of breast radiation] with [non-surgical sentinel lymph node mapping+single treatment of SABR]. It has the potential to eliminate surgery-related side effects, improve breast preservation and dramatically reduce treatment time.

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