Advertisement

Breast Radiation: Shorter as Good as Longer

September 27, 2013

Breast Radiation: Shorter as Good as Longer

  1. William J. Gradishar, MD

Long-term data support hypofractionated radiotherapy after primary surgery for early breast cancer.

  1. William J. Gradishar, MD

Despite the convenience and potential cost-savings of shorter courses of adjuvant breast cancer radiation, concerns about this approach have focused on long-term local control and cosmesis. Prior trials have allayed these fears to some degree, but most U.S. clinicians have been cautious about adopting shorter radiation courses, citing inadequate long-term follow-up as the primary concern. Now, U.K. investigators report long-term results of the randomized, controlled, Standardisation of Breast Radiotherapy trials (START-A and START-B), which evaluated various doses and schedules of postoperative breast radiation in women with completely excised invasive breast cancer.

In START-A, 2236 patients were randomized to 50 Gy in 25 fractions over 5 weeks versus either 41.6 Gy or 39 Gy in 13 fractions over 5 weeks. At a median follow-up of 9.3 years, 10-year rates of local-regional relapse did not differ significantly between the 41.6 Gy and 50 Gy groups or between the 39-Gy and 50-Gy groups. Moderate or marked breast induration, telangiectasia, and breast edema were significantly less common normal-tissue effects in the 39-Gy group than in the 50-Gy group. Normal tissue effects were similar in the 41.6-Gy and 50-Gy groups.

In START-B, 2215 patients were randomized to 50 Gy in 25 fractions over 5 weeks versus 40 Gy in 15 fractions over 3 weeks. At median follow-up of 9.9 years, 10-year rates of local-regional relapse were similar in both groups. Breast shrinkage, telangiectasia, and breast edema were significantly less common normal-tissue effects in the 40-Gy group than in the 50-Gy group.

Comment

Long-term results of the START trials, and a prior Canadian trial (N Engl J Med 2010; 362:513), support the alternative, shorter schedule of radiation therapy for patients with early-stage breast cancer after undergoing breast-conserving therapy.

  • Disclosures for William J. Gradishar, MD at time of publication Consultant / Advisory board Biologics, Inc.; Celgene; Myriad; Novartis Grant / research support Breast Cancer Research Fund Editorial boards Clinical Breast Cancer; Journal of Clinical Oncology; Oncology

Citation(s):

Reader Comments (1)

naomi tamerin Physician, Pathology, Retired

interested in this topic..Thanks

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement