August 6, 2015 -- UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER -- Women who receive a shorter course of whole breast radiation therapy for early stage disease experience less toxicity and improved quality of life compared to those who undergo a longer course of treatment, researchers report from The University of Texas MD Anderson Cancer Center.

Published in JAMA Oncology, the authors believe these findings should be communicated to women as part of the shared decision-making between breast cancer patients and their physician.

Historically in the management of breast cancer in the U.S., radiation treatment has been given in smaller doses over a longer period of time, in a method called conventionally fractionated whole breast irradiation (CF-WBI), rather than with higher doses over a shorter period of time, or hypofractionated whole breast irradiation (HF-WBI).
Decades ago, the U.S. radiation oncology community looked at abbreviating treatment time with disappointing results, explains MD Anderson's Simona Shaitelman, M.D., assistant professor, Radiation Oncology.

"Those studies were done with now-antiquated technologies," says Shaitelman, the study's first author. "Since then, with advances in technology, randomized studies in the United Kingdom and Canada have shown equal rates of recurrence in both groups, as well as equal survival. Yet our radiation oncology community has been slow to adopt the practice."

In fact, the MD Anderson researchers note that only one-third of patients for whom HF-WBI is currently recommended as appropriate treatment by the American Society of Radiation Oncology (ASTRO) actually receive the shorter course of therapy.

"So the question is, with modern technology, and knowing that the survival and recurrence outcomes are equal, can we offer patients a better option? It was essential that we look at how we were giving therapy and if that therapy impacted patients' quality of life, both acutely during treatment and in the short-term after treatment."

For the prospective, unblinded trial, 287 women with early breast cancer were randomized to receive either CF-WBI or HF-WBI, 149 and 138 patients, respectively. All were 40 years of age or older, treated with breast conserving surgery and had Stage 0 - 2 disease; 76 percent of the patients were overweight or obese. Of note, previous studies with HF-WBI excluded patients with a larger body mass index (BMI), despite obesity being a strong associated risk factor for the disease.

Also, the MD Anderson study included a "boost dose" as part of the treatment. The researchers note that previous HF-WBI studies did not systematically look at this practice of giving additional treatment to target the tumor bed with a higher dose.

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