Shorter radiation course recommended for early-stage breast cancer patients

Early-stage breast cancer patients who received a shorter course of wholebreast radiation at higher doses reported equivalent cosmetic, functional and pain outcomes over time as those who received standard therapy consisting of a longer, lower-dose course of treatment, according to an MD Anderson study.

Published in the journal Cancer, the study found patient-reported functional status and breast pain improved significantly
following both radiation schedules, and there were no significant differences in physician-reported cosmetic evaluations.

With equivalent outcomes, the authors suggest the shorter course as the preferred option for patients because of a more convenient treatment schedule.

“In the United States, women historically have been treated with conventionally fractionated whole-breast irradiation (CF-WBI), given in smaller doses over a longer period of time, rather than hypofractionated whole-breast irradiation (HF- WBI), which consists of higher doses for a shorter treatment period,” explains Benjamin Smith, associate professor of Radiation Oncology.

Large randomized trials from Canada and the United Kingdom have established HF-WBI as a safe and effective treatment for nearly all patients with early-stage breast cancer. In previously published research, the authors showed patients receiving HF-WBI experienced less acute toxicity and post-radiation fatigue compared to those treated with CF-WBI.

However, the adoption of HF-WBI has been limited in the U.S. In fact, researchers note only one-third of patients for whom HF-WBI is currently recommended by the American Society of Radiation Oncology (ASTRO) actually receive the shorter course of therapy.

“This trial is particularly important because there is still some hesitation among clinicians in the U.S. about adopting the
hypofractionated schedule,” says lead author Cameron Swanick, M.D, a resident in Radiation Oncology. “Because American patients tend to have a higher prevalence of obesity, and because prior trials excluded certain patients with high body mass index, there has been this concern that the shorter radiation treatment course may not be as safe for American patients.”

The researchers continue to follow tumor control outcomes, though, to date, no meaningful difference in survival has been found. All outcomes will be reported once all patients have completed three-year follow-up.

The results of this and previous studies further support the use of HF-WBI as the preferred radiation therapy for early- stage breast cancer patients, explained Smith.

“At MD Anderson these shorter courses have become the standard of care.”