More Good News for Breast Cancer Patients.. Protective Radiotherapy Can Be Completed Sooner!

Two long-term studies in The Lancet Oncology suggest hypofractionated radiotherapy (fewer fractions with higher doses over a shorter period) is effective in early breast cancer compared with previous standard regimens.

After surgery and chemotherapy, radiotherapy commonly eliminates potentially remaining invisible cells. Particularly with large tumors or multiple underarm nodes, standard treatment lasts five weeks, with 5 weekdays of treatment and total 50 Gy. This means a long process and concern about high radiation.

Hypofractionation gives fewer, higher-dose sessions over a shorter time, but a lower total radiation dose.

British START-A and START-B studies investigated early-stage effects at 35 centers. Women older than 18, totaling 4,451, received standard or hypofractionated treatment after surgery and chemotherapy. START-A used more than 5 weeks with 13 fractions of 41.6 Gy or 39 Gy; START-B used more than 3 weeks with 15 fractions of 40 Gy. Both compared standard treatment over more than 5 weeks with 25 fractions of 50 Gy.

After average follow-up of 9.3 years in START-A, among 139 with regional recurrence, standard 50 Gy had %7.4, 41.6 Gy had %6.3 and the 39 dose regimen had %8.8 recurrence.

After average follow-up of 9.9 years in START-B, among 95 with regional recurrence, the 40 Gy regimen had %4.3 and the 50 Gy regimen had %5.5 recurrence.

Normal tissue effects differed. START-A showed small differences between 41.6 and 50 dose regimens, while breast edema, telangiectasia (spider-vessel lesions from dilated vessels) and firmness were rarer with 39 Gy than 50 Gy. START-B found less shrinkage, telangiectasia and edema with 40 Gy than 50 Gy.

After 10 years of observation in both studies, researchers concluded that hypofractionated radiotherapy did not significantly change regional cancer recurrence rates compared with standard treatment. However, the findings indicated lower radiation effects on normal tissues with hypofractionation.

Hypofractionation was therefore considered safe and effective. These findings suggest international adoption of 15 fractions of 40 Gy, already standard in British early breast cancer care.

Successful use of lower, less harmful doses of unpleasant but necessary treatments delights oncologists. Rapidly incorporating proven approaches helps patients have a more comfortable treatment experience. Positive findings from such well-designed studies in the respected Lancet Oncology are welcome for patients.