June 15, 2016, University of Texas M.D. Anderson Cancer Center -- Early-stage breast cancer patients receiving a shorter course of whole breast radiation with higher radiation doses per fraction reported equivalent cosmetic, functional and pain outcomes over time as those receiving a longer, lower-dose per fraction course of treatment, according to researchers from The University of Texas MD Anderson Cancer Center.

Their study, published in Cancer, found patient-reported functional status and breast pain improved significantly following both radiation schedules, and there were no significant differences in physician-reported cosmetic evaluations. With a more convenient treatment schedule and equivalent outcomes, the authors suggest the shorter course as the preferred option for patients.

In the United States, women historically have been treated with conventionally fractionated whole-breast irradiation (CF-WBI), given in smaller doses over a longer period of time, rather than hypofractionated whole-breast irradiation (HF-WBI), which consists of higher doses for a shorter treatment period.
Large randomized trials from Canada and the United Kingdom have established HF-WBI as a safe and effective treatment for nearly all patients with early-stage breast cancer. In previously published research, the authors showed patients receiving HF-WBI experienced less acute toxicity and post-radiation fatigue compared to those treated with CF-WBI.

However, the adoption of HF-WBI has been limited in the U.S. In fact, researchers note only one-third of patients for whom HF-WBI is currently recommended by the American Society of Radiation Oncology (ASTRO) actually receive the shorter course of therapy.

"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. "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."

For the prospective, unblinded trial, 287 women with stage 0-II breast cancer were randomized to receive either CF-WBI (149 patients) or HF-WBI (138 patients). All women also received a "boost dose," an additional treatment targeting the tumor bed with a higher dose, which has not been systematically analyzed in previous HF-WBI studies.

Medical Research Homepage