Years ago, there was just one way to do breast radiation: six weeks of daily (Monday through Friday) external-beam radiation to the entire breast. Today, women have choices, and the choices can be overwhelming. Which radiation regimen is best?

The bottom line is, we don't know yet. These options are still being tested in clinical trials. When these trials are completed, we will hopefully be able to compare the outcomes (both for their cosmetic results and in terms of their rates of local recurrence) of these newer options to the old standard six-week therapy.

Here are some of the radiation-therapy options currently being tested:

• Mammosite radiation. This method involves the insertion of a balloon at the time of the lumpectomy surgery. If needed, the radiation is later delivered through catheters inserted through this balloon device so that the breast is basically radiated from the inside out. This way, only the specific area where the cancer originally grew is radiated, instead of the entire breast. This is known as partial-breast radiation. Treatment is completed in one to two weeks. Some issues that have arisen so far at the breast centers offering this type of therapy relate to balloon placement - what do you do if the margins were "dirty" and the surgeon needs to go back in and operate again? In that case, the balloon placement has to be redone. Also, some balloons have ruptured, resulting in additional surgery to insert a new one. We don't yet know how well this method works. Thousands of women must be enrolled and watched for several years to find out if it works as well as the standard method.
• Accelerated radiation. This is external-beam radiation and involves giving higher dosages over a shorter period of time. Curiously enough, despite the higher dosages, the preliminary results don't show an increase in skin burning with this method. Comparison of outcomes is still pending.
• External-beam, partial-breast radiation. This method involves radiating just the breast where the cancer originally grew, along with a margin of tissue around it since this area is the most likely place to watch for the return of the cancer. This therapy is done twice daily for five days. It's fast and furious, and many women like the option of shortening their radiation therapy from six weeks to one week. Again, however, we don't yet know how the final results of this method will compare to others.

So how do you decide which option to choose if you are offered one of the newer methods as well as the traditional six weeks of radiation?

• Talk to at least two radiation oncologists who specialize in breast cancer.
• Discuss the size of the margins that were clear of cancer and the size and location of your original tumor.

This will help narrow down the options. Participating in a clinical trial can also be a terrific thing and it ensures that you'll be carefully monitored long term.

But in the end, you need to go with your gut. If the traditional six-week method still feels like the best option for you, go with it.