Shorter-Course Breast Irradiation

Summary and Comment |
August 12, 2015

Shorter-Course Breast Irradiation

  1. Henry Mark Kuerer, MD, PhD, FACS

Women undergoing lumpectomy experienced less toxicity with fewer but larger fractions of adjuvant radiotherapy.

  1. Henry Mark Kuerer, MD, PhD, FACS

Whole-breast irradiation using hypofractionation (HF; e.g., 40 to 42 Gy in 15 to 16 fractions) has been shown in randomized trials from Canada and the U.K. to be as effective as conventional fractionation (CF; 50 Gy in 25 fractions) in reducing breast cancer recurrence. However, HF has not been widely embraced in the U.S., largely because of concerns about toxicity with higher fraction sizes as well as differences in U.S. patients (which have higher body-mass index than their foreign counterparts) and in U.S. practice (which routinely employs boost radiation). Now, two multicenter U.S. trials compare the toxic effects of HF versus CF adjuvant radiotherapy in women undergoing breast-conserving surgery for early breast cancer.

In the study by Shaitelman and colleagues, 287 patients undergoing lumpectomy for stage 0–2 disease were randomized to receive either HF (138 patients) or CF (149 patients), followed by boost radiation; 76% of patients were overweight or obese. Fewer patients receiving HF versus CF experienced acute grade 2 or higher toxic effects (47% vs. 78%; P<0.001). At 6 months, fewer patients receiving HF reported a lack of energy (23% vs. 39%; P<0.001) or difficulty meeting family needs (3% vs. 9%; P=0.01).

In the study by Jagsi and colleagues, 2309 patients undergoing lumpectomy received either HF (578 patients; 60% received boost) or CF (1731 patients; 93% received boost); 73% were overweight or obese. Fewer patients receiving HF versus CF had skin reactions (moist desquamation, 6.6% vs. 28.5%; P<0.001; grade 2 or higher dermatitis, 27.4% vs. 62.6%; P<0.001), breast pain (moderate/severe, 24.2% vs. 41.1%; P=0.003), or fatigue (18.9% vs. 29.7%; P=0.02).

Comment

These results have major implications for patients receiving radiotherapy following breast-conserving therapy. A simple adjustment of radiation dosing lowers cost and increases patient convenience while reducing pain, fatigue, and skin reactions. Based on these studies, shorter-course radiotherapy is preferable when whole-breast radiation is necessary for early breast cancer.

Editor Disclosures at Time of Publication

  • Disclosures for Henry Mark Kuerer, MD, PhD, FACS at time of publication Consultant / Advisory board Lightpoint Medical, Inc. Speaker's bureau Physicians’ Education Resource, LLC Royalties McGraw-Hill Professional; UpToDate, Inc. Grant / Research support National Cancer Institute; Genomic Health, Inc. Editorial boards Annals of Surgical Oncology Leadership positions in professional societies NRG Oncology (Institutional PI and Breast Committee); Society of Surgical Oncology (Chair, Curriculum Ad Hoc Committee, Breast Program Directors)

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