Uninterrupted Radiotherapy Improves Survival in Triple-Negative Breast Cancer
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After breast cancer surgery, interruptions during adjuvant (protective) radiotherapy were associated with poorer overall survival in patients with triple-negative breast cancer (TNBC), according to a new study. The study was published in The Journal of the National Cancer Institute on 3 July 2023.
Triple-Negative Breast Cancer and Radiotherapy
Triple-negative breast cancer (TNBC) has aggressive biology and is generally more common in younger women. For patients with TNBC, radiotherapy is often used to destroy cancer cells that may remain after surgery and reduce recurrence risk. This study focused on how interruptions during treatment affect overall survival.
Treatment Interruptions and Overall Survival
The researchers found that interruptions, even those lasting 2 days, significantly affected overall survival. They analysed US National Cancer Database records for 35,845 patients treated for TNBC between 2010-2014.
Treatment Duration and the Effect of Interruptions
More interruptions that prolonged treatment were associated with poorer overall survival.
According to the results:
- Compared with patients experiencing 0-1 days of interruption, those with 2-5 days had a 6.9% higher risk of death (hazard ratio [HR], 1.069; 95% CI, 1.002-1.140).
- Death risk also increased for patients with interruptions of 6-10 and 11-15 days.
Important note: In this study, interruption means unexpected or unplanned treatment breaks, not the normal weekend breaks in a radiotherapy schedule. Not receiving radiotherapy at weekends is a normal part of the plan and generally allows patients to recover before continuing.
Commentary
The researchers said this was the first study reporting the relationship between radiotherapy interruptions and overall survival in people with non-metastatic triple-negative breast cancer, meaning cancer not at stage 4. They also said treatment breaks to let the skin heal should not be encouraged.
Minimising interruptions is one of the most important steps in improving outcomes. Skin-protection measures should be used consistently to prevent radiation dermatitis. Exploring alternative treatment approaches to reduce potential radiation adverse effects is also important.
Interest has grown in shorter radiation treatment courses, or hypofractionation. Very short courses, or ultrahypofractionation, are also used in some cases. These approaches may reduce interruptions and make treatment more efficient.
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