Lower Total Radiotherapy Dose with Fewer Larger Treatments as Effective for Breast Cancer Patients

A lower total dose of radiotherapy, delivered in fewer, larger treatments has been demonstrated to be as effective as the international standard of a higher total dose delivered over a longer time to treat women with early breast cancer.

According to a study published in the March 2008 issue of the journal Lancet and Lancet Oncology, this confirms long-held beliefs of cancer specialists who have been using shorter schedules for many years. Nearly 4,500 women took part in the Standardization of Breast Radiotherapy (START) trials coordinated by the Clinical Trials and Statistics Unit at the Institute of Cancer Research (London, UK) and funded by Cancer Research UK (London, UK), the Medical Research Council (London, UK), and the UK Department of Health. Just under half the women received the international standard radiotherapy delivering 25 treatments, treating five times per week over five weeks. The remainder of study participants received a lower total dose given in fewer, larger treatments in either three or five weeks.

Researchers then compared the rate of cancer recurrence in the treated breast combined with the effects of the treatment on surrounding healthy breast tissues. After a median follow-up of five to six years, the rate of recurrence in the breast remained very low for patients in each of the treatment groups studied. The rate of side effects were low overall, and no higher in women receiving the revised treatment than those receiving the international standard of 25 treatments. The results suggested that a lower total dose given in fewer larger treatments is as safe and effective in treating early stage breast cancer as the longer standard schedule.

Shorter radiotherapy treatments have been used in the United Kingdom for many years with promising results but this is the first systematic and consistent evaluation to compare the longer international treatment and the shorter revised UK treatment.

The benefits of fewer sessions of radiotherapy to patients with early breast cancer mean fewer trips to the hospital for treatment, which then mean less disruption in a daily routine. Reducing the number of trips to the hospital is also financially beneficial to patients. The results also offer new insights into how breast cancer cells handle radiotherapy damage to the DNA, suggesting how treatments might be improved further.

Lead investigator, Prof. John Yarnold, from The Institute of Cancer Research, said, "These trials represent a successful 10-year collaboration between cancer specialists, and several thousand women motivated to help others by volunteering for research. The results suggest that a high total dose given in 25 small treatments is no better than simpler schedules using fewer exposures to a lower total dose. Shorter therapies giving fewer, larger treatments are obviously convenient for patients. The results support the current use of shorter schedules in the UK and in other countries.”

Sir Leszek Borysiewicz, chief executive of the Medical Research council, said, "This research will help to refine the way we treat women who are battling this disease. The research will lead to fewer sessions of radiotherapy. This work will help patients with early breast cancer. They'll have to go to hospital for treatment less often which means fewer trips to cancer units. But the results will also help us to understand this disease better at a genetic level so we can make treatments even better in the future.”


Related Links:
Institute of Cancer Research
Cancer Research UK
Medical Research Council