Subspecialized expertise in breast radiation therapy

Advanced radiation technology is only part of the equation for delivering high-quality breast cancer care. Sophisticated treatment planning and clinical judgment guided by experience and expertise are also critical.

“It’s easy to deliver standard breast radiation therapy. It’s harder and more time-intensive to be thoughtful about it,” says radiation oncologist Neil Taunk, MD, MSCTS, chief of the breast radiation service at Penn Medicine. “My partners and I provide thoughtful, expert care to patients with breast cancer seeking treatment.”

At Penn Medicine, that expertise is supported by high clinical volumes, subspecialized care for even the most complex cases, and research that shapes the field of breast radiation.

Experience built on volume, subspecialty leadership, and education

Penn Medicine is one of the highest-volume centers for radiation therapy in the nation, delivering approximately 11,000 courses each year, nearly 2,000 of which are breast cancer cases for all indications including adjuvant, recurrent, and metastatic disease. “This means that the breast radiation care at Penn Medicine alone is larger than the entire radiation volumes of many community cancer centers,” Dr. Taunk notes.

This volume enables a level of subspecialization most centers can’t offer. “The majority of breast radiation therapy in the U.S. is performed by qualified generalists in radiation oncology,” says Dr. Taunk. “Here, you get the benefit of physicians who are entirely or nearly entirely majority sub-specialized within breast cancer care.”

Penn Medicine is also home to the largest proton therapy center in the world. By using high-energy proton beams that deposit radiation at a defined depth with minimal exit dose, proton therapy reduces radiation exposure to surrounding healthy tissue and adjacent organs by comparison to conventional photon therapy—an important consideration in left-sided breast cancers and cases requiring nodal irradiation.

But with regard to proton therapy, volume and expertise aren’t the whole story. Penn radiation oncologists have trained the majority of the world’s new proton therapy users via our educational and residency programs, and led the completion of the largest randomized proton therapy clinical trial ever conducted (RadComp). “We’ve treated over 11,000 patients with proton therapy in the largest integrated academic proton therapy center in the world, so we have among the most experience,” says Dr. Taunk.

At Penn Medicine, every patient benefits from treatment recommendations ultimately driven by clinical expertise and judgment. The team approaches every treatment plan with that extensive experience. “Physicians have the freedom to offer a patient whatever we think best aligns with the patient’s goals and can offer patients the same treatment at any campus within our geographic footprint,” Dr. Taunk explains. This model supports treatment decisions focused solely on clinical need, ensuring patients receive the most appropriate care, rather than more care, and allows convenient, high-quality treatment closer to home.

Re-evaluations and second opinions

Although all new patients who come to Penn Radiation Oncology are evaluated by the division’s radiation oncologists, patients often select Penn Medicine for the comprehensive resources available to support them during treatment, as well. This may include consultation or advice on their current/primary treatment recommendation.

“We have many patients that come for second opinions, and unless a patient specifically wants treatment here, we actually send the majority of those patients back,” says Dr. Taunk, referring to the patients’ home providers. “If we can offer them something unique such as a technology or treatment schedule, we'll let them know, but otherwise we’re happy to confirm, ‘Your [local] doctor is doing a great job.’”

When patients choose to remain at Penn Medicine, it’s because their clinical needs and the institution are well aligned. “Our radiation oncologists have very thoughtful, nuanced discussions about breast radiation,” Dr. Taunk says. “It’s difficult to beat the subspecialty expertise that’s offered here.” Another reason patients seek care at Penn Medicine, he observes, is that Penn Radiation Oncology supports its comprehensive care with expansive resources, including social service providers who help patients unable to drive to appointments or who need financial assistance, as well as nutritionists, cancer support groups, outstanding nursing care, clinical trials, and supportive care services.

Minimizing treatment time and side effects

Penn Medicine specialists tailor radiation schedules to each patient’s diagnosis and needs, often completing treatment in a fraction of the time required elsewhere.

Whole breast radiation

Typically, whole breast radiation takes three to six weeks. At Penn Medicine, experts have leveraged their experience to tighten this schedule significantly without compromising outcomes. “We’re treating nearly every woman, those with early stage as well as advanced breast cancer, in three weeks or less, including the ‘boost’ portion when indicated,” says Dr. Taunk, adding that an increasing number of women are treated in one week or less.

Partial breast radiation

Partial breast radiation allows patients with early-stage breast cancer to complete treatment in as few as five consecutive days and with fewer side effects. “We treat a relatively high proportion of patients with partial breast radiation, anywhere from 15 to 20 percent,” says Dr. Taunk. “These patients experience less tiredness and fewer skin side effects and have a faster recovery. It’s generally a minimal impact on their quality of life.”

Advanced treatments for complex anatomies

Recurrent, metastatic, and left-sided breast cancer, as well as other complex cases, require a level of precision and expertise that most centers cannot consistently deliver. The Penn Medicine team specializes in these cases.

Penn Medicine treats many women each year with re-irradiation, making it one of the most experienced referral centers in the region. For women with recurrent breast cancer, re-irradiation offers the possibility of keeping their breasts and minimizing the dose to the heart and lungs during a second course of radiation, especially with proton therapy. This technique requires specialized technology and a high level of expertise that is not widely available. “We have significant expertise and knowledge of long-term side effects in re-irradiation for breast cancer,” says Dr. Taunk.

Radiation therapy may also be used to precisely target metastatic disease in select patients, helping control symptoms and, in some cases, delay or avoid changes to systemic therapy. In select patients, this approach may be beneficial.

When breast cancer is present in the left breast, Penn Medicine radiation oncologists work with cardiologists dedicated to breast cancer care. This cardio-oncology collaboration, which develops and implements evidence-based strategies to protect the heart during treatment, includes physicians such as cardiologist Dr Bonnie Ky and radiation oncologists Dr. Gary Freedman and Dr. Eva Berlin. “We have deep research and technical expertise in breast radiation therapy to spare the heart,” says Dr. Taunk.

Penn Medicine’s research in this area through the Thalheimer Center for Cardio-Oncology has identified key factors that influence cardiac function during breast radiation, leading to clinical changes such as the use of low radiation doses, proton therapy, prone breast radiation, radiation therapy, and deep inspiration breath hold (DIBH) to minimize cardiac exposure.

Consistent quality across locations

Breast radiation therapy is delivered across Penn Medicine locations using shared clinical protocols, centralized quality assurance, and a standardized planning approach to ensure consistency in treatment recommendations and execution. This approach allows patients to receive the same high-quality care at locations closer to home, improving access and reducing treatment burden without compromising outcomes.

Penn Medicine is currently implementing AI-based technologies to further strengthen and ensure consistency, including semi-automating the planning process to further improve quality and precision across the system and allow patients to start treatment more quickly. “The quality assurance process and standardization are rigorous. This means that we do our best to make sure the opinion and treatment that you’ll get at one Penn location will be the same at any location,” says Dr. Taunk.

Referrals and consultations

To refer a patient to Penn Medicine Radiation Oncology, please call 877-937-7366, or refer a patient online.