Mar 20 2008
A LOWER total dose of radiotherapy, delivered in fewer, larger treatments has been shown 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 new research published in the Lancetand Lancet Oncology.
This confirms long-held beliefs of cancer specialists in the UK who have been using shorter schedules for many years.
Colour-enhanced image of a breast cancer cell: Cancer Research UK.
Nearly 4,500 women took part in the START Trials co-ordinated by the Clinical Trials and Statistics Unit at The Institute of Cancer Research and funded by Cancer Research UK, the Medical Research Council and the 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 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 along with the effects of the treatment on surrounding healthy breast tissues.
After an average 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 UK for many years with promising results but this is the first systematic and reliable 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 in turn mean less upheaval 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.
Chief Investigator, Professor John Yarnold, from The Institute of Cancer Research and the Royal Marsden Hospital, 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.”Professor Mike Richards, National Cancer Director, said: “We welcome these findings which show that women receiving radiotherapy for breast cancer can be effectively treated with fewer hospital visits. These results are good for patients and good for the NHS.”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.”Dr Lesley Walker, Cancer Research UK's director of cancer information, said: “Cancer treatment disrupts the lives of patients and their families for many weeks at a time so this is a really positive result. Fewer doses of radiotherapy that don't increase side-effects while providing the same benefits means less time at hospital and more time at home. It is important for patients that we continue research like this to fine tune current treatment.”
Original research paper: START Trial - Standardisation of Breast Radio Therapy. Results of the START Trial B study are published in the Lancet and results of the START Trial A study are published in Lancet Oncology.
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