Researchers from The University of Texas MD Anderson Cancer Center found that early-stage breast cancer patients who received a shorter course but higher doses of radiation (hypofractionated irradiation) benefited the same as patients who received a longer, lower-dose course (conventionally fractionated irradiation).
The study, “Longitudinal analysis of patient-reported outcomes and cosmesis in a randomized trial of conventionally fractionated versus hypofractionated whole-breast irradiation,“ appeared in the medical journal Cancer.
The scientists found that breast pain improved with both radiation schedules, and there were no differences in cosmetic appearance, based on physician reports.
“This trial is particularly important because there is still some hesitation among clinicians in the U.S. about adopting the hypofractionated schedule,” said lead author Cameron Swanick, M.D., resident, Radiation Oncology, in a press release. “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.”
In the study, 287 women with breast cancer received one of the two treatments. All of the study subjects were at least 40 years old, and most were overweight or obese (76 percent). Measurements were made at the beginning of the study, as well as six months, and one, two, and three years after the treatment.
“There were no significant differences between the treatment arms for any PROs [patient-reported outcomes] at baseline, six months, one year or three years,” Swanick said. “At two years, outcomes from the Functional Assessment of Cancer Therapy Breast trial outcome index were modestly higher in the hypofractionated group.”
No statistically meaningful differences in physician-reported cosmetic scores occurred at any time point. Additionally, both groups had similar improvement in breast pain.
Overall, the authors suggested that a short course of radiation with higher doses may be a preferred treatment for breast cancer. “At MD Anderson these shorter courses have become the standard of care,” said Dr. Benjamin Smith, M.D., associate professor of radiation oncology and the study’s senior author.
“This was the first investigator-initiated randomized trial conducted in the network,” Smith said. “It was a success because of the support of our partners and illustrated the potential, promise, and power of our network to help achieve our mission.”
Smith is a leader on an ASTRO (American Society for Radiation Oncology) guideline panel on whole-breast irradiation. He feels that studies such as this will support the development of new guidelines for the treatment of breast cancer.