Shorter courses of radiotherapy can treat breast cancer
Publication Date:19/03/2008
A short course of radiotherapy with a lower overall dose of radiation may work just as well for breast cancer as a higher dose, and is less likely to cause skin changes, according to two new studies. A lower dose can be split into 15 or so radiotherapy sessions, instead of the usual 25, meaning fewer trips to hospital. However, researchers need to do more research to make sure short courses of radiotherapy work well in the long term.
What do we know already?
Many women with breast cancer are able to have an operation that removes only the lump, allowing them to keep the rest of their breast. Radiotherapy is used to kill any cancer that might have been left behind after surgery. Radiotherapy can also be used after an operation to remove the whole breast (a mastectomy).
Radiation kills cancer cells, but it can also damage healthy tissue. To reduce this damage, the overall dose of radiotherapy is split into lots of small doses. A typical course of radiotherapy for breast cancer might involve 25 individual doses. Going to hospital for each one of these sessions can be inconvenient and tiring.
Doctors suspect that having a smaller overall dose split into fewer, larger individual doses could be just as good as traditional radiotherapy. It would also mean fewer hospital trips. In fact, shorter courses of radiotherapy have been used for many years in the UK, but it's never been shown for certain how well they work.
Researchers have now published two studies looking at shorter courses of radiotherapy. They hoped to find a treatment regime that works just as well as standard radiotherapy, but is more convenient for patients.
What do the new studies say?
Shorter courses of radiotherapy work just as well for breast cancer as traditional, longer treatments. After 5 years, between 3 in 100 and 5 in 100 women had cancer come back in their breast or nearby. But the chances of cancer coming back were about the same for all the women, whether they'd had a shorter or longer course of radiotherapy.
However, women in the studies were only followed up for about five years. The trials are continuing, and researchers plan to publish long-term results in the future. Although the studies are very promising, they'll need to run for another 10 or 15 years to say for sure how good the new radiotherapy regimes are.
Tell me more about the studies' findings
Doses of radiotherapy are measured in units called Grays (Gy). The standard dose for breast cancer is 50 Gy. The total dose is split into 25 individual doses. This is often inconvenient for patients, as it means going to hospital every weekday for five weeks.
Both of the new studies looked at radiation doses of around 40 Gy. In one study, this was split into 13 individual doses, which were spread over five weeks. In the other study, 15 individual doses were given in just three weeks.
Although the overall dose of radiation is lower, having fewer sessions means that each individual treatment has a higher dose. Doctors were worried that this might cause more side effects. The new studies show this isn't the case after five years, although it might take longer for more serious side effects to appear. Radiotherapy to the chest area can cause damage to the heart or ribs, although this is becoming less common as radiotherapy equipment improves.
In the short term, shorter courses of radiotherapy may actually be better for preventing side effects. Women who had the newer radiotherapy regimes were less likely to get changes affecting the way their breast looked, such as damage to the skin on their breast.
Where do the studies come from?
Both trials are part of a large project called START (standardisation of breast radiotherapy). It's being run by a large group of researchers based at universities, hospitals and research centres across the UK.
How reliable are the findings?
Both studies looked at more than 2,000 women and were done in a reliable way. The main problem is that most women who took part have only been followed up for five or six years. The research is still ongoing, and long-term results are expected in the future.
The other slight problem is that the studies looked at a mixed group of women. Some patients were having chemotherapy or the drug tamoxifen, and some were given an extra boost of radiotherapy as part of their treatment. This makes it harder to say which particular groups of women might be suitable for a lower dose of radiotherapy.
What does this mean for me?
If you're being treated for breast cancer, the doctors and nurses in charge of your care will offer advice, and help you choose the best combination of treatments for you. It's possible that a shorter course of radiotherapy could be suitable. This may make treatment less tiring, since you won't have to make as many trips to hospital.
What should I do now?
The kind of treatment someone needs for breast cancer depends on lots of things, such as how far the tumour has spread and how fast-growing it is. Ask your doctor if you're interested in a shorter course of radiotherapy. He or she can help you decide if it's right for you.
Diagnosing breast cancer at an early stage makes it easier to treat. In the UK, breast screening is offered routinely to all women aged between 50 and 70. Younger or older women can also be screened if they wish. If you notice a change in your breasts at any age, see your GP as soon as you can. However, try not to worry, as most breast changes aren't linked to cancer.
From:
The START Trialists' Group. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. The Lancet Oncology. Published online 19 March 2008.
The START Trialists' Group. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. The Lancet. Published online 19 March 2008.
To read more, see our information on breast cancer.
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