- Researchers say three weeks of radiation treatment is just as effective as six weeks for people with early-stage breast cancer.
- Experts say the reduced treatment regimen is more convenient and provides a better quality of life for most patients.
- Researchers have started to look at even shorter treatments for some people with breast cancer.
A shorter course of higher-intensive radiation treatment is just as effective for treating early-stage breast cancer as a longer regimen of lower-dose radiation, a new study finds.
The findings could lead to patients only needing three weeks of radiation therapy after a lumpectomy, as opposed to the current treatment standard of four to six weeks.
Researchers said past studies have shown that three weeks of radiation is as safe and effective as longer treatment regimens among patients with a low risk of tumor recurrence.
The new study, which hasn’t been published yet in a peer-reviewed journal, concluded that the same is true for patients who qualify for breast-conserving therapy but face a higher risk of tumor recurrence due to slightly larger tumor size or other factors.
Dr. Frank Vicini, the lead study author and a radiation oncologist as well as the national director of research and breast care services at GenesisCare, said most patients he sees in his practice fall into the latter group.
“Three weeks of radiation after lumpectomy is just as effective for patients who have a higher risk of recurrence as it is for lower-risk patients,” said Vicini, who presented his findings at the recent American Society for Radiation Oncology (ASTRO) Annual Meeting, in a press release. “This approach cuts treatment time for these patients in half.”
The researchers reported that delivering a high dose of radiation to the surgery site during the three weeks of whole breast irradiation therapy had similar outcomes to waiting until after the whole breast treatment to target the surgical site.
“Adding a radiation boost reduces the likelihood of tumor recurrence in the breast by 20 to 30 percent, but delivering that boost after hypofractionated radiation therapy adds another week to treatment,” said Vinci. “This can be challenging for patients who need to take time off work or travel long distances for treatment.”
Dr. Rachel Jimenez, an assistant professor of radiation oncology at Harvard Medical School and the chair for quality and safety in the Department of Radiation Oncology at Massachusetts General Hospital, told Healthline, “I expect that the results of this study will be embraced by many of us who treat patients with breast cancer, as a shorter treatment schedule has a positive impact on equity in cancer care delivery and patient quality of life.”
“This study reveals a promising avenue to reduce the burden of treatment on patients by improving quality of life while achieving the same outcomes,” Dr. Dorraya El-Ashry, the chief scientific officer at the Breast Cancer Research Foundation, told Healthline. “While we need further validation to impact clinical care, we are constantly striving to help patients live fuller lives without sacrificing quality of care.”
Researchers compared a group of patients who received conventional whole breast radiation delivered over four to five weeks followed by a radiation boost to the lumpectomy site delivered over six to seven days to a group that received hypofractionated whole breast radiation delivered over three weeks with the boost to the surgical site delivered concurrently over those three weeks.
Among the concurrent treatment group, the 5-year tumor recurrence rate was less than 2 percent and the 7-year recurrence rate was less than 3 percent, compared to about 2 percent at both intervals among the conventional treatment group.
There also were no significant differences in cosmetic appearance or side effects.
“While there have been, and continue to be, clinical trials that focus on improving the efficiency of breast radiotherapy, this is a large-scale trial that enrolled a sizable portion of ‘high-risk’ patients, including those with high-grade disease and/or estrogen receptor-negative biology,” said Jimenez. “It showed, even among a higher risk cohort, excellent cancer control rates with this compressed treatment schedule.”
Vinci noted that delivering a concurrent dose of radiation requires a high level of sophistication among treatment providers.
“I expect that physicians looking to adopt this approach will need to consider the technical nuances that accompany this integrated treatment technique, but this should not represent a significant barrier to adoption,” said Jimenez.
Future studies will examine whether the shorter course of treatment is also safe and effective for patients whose cancer has spread to the lymph nodes.
Researchers also want to look at whether an even shorter cause of treatment can work. Researchers from the United Kingdom, for example, are testing a one-week course of radiation for lower-risk patients.
“I used to treat patients with much longer courses of radiation, daily for 6 to 7 weeks,” said Dr. Robert Wollman, a radiation oncologist and medical director of the Vasek Polak Radiation Oncology Department at Providence Saint John’s Health Center in California. “For the past 10 years or so, the majority of patients get four weeks (20 daily treatments) in my practice. And some patients can even get five treatments (just one week).”
“This study gives kind of a ‘middle ground’ for patients with higher risk features who can now be finished in as short as three weeks or 15 treatments,” Wollman told Healthline. “It’s very nice to know that we can get the same result killing the cancer while sparing patients a lot of time without any risk of more side effects.”