Early-Stage Breast Cancer Treatment May Become Shorter, More Effective

Breast cancer patients who receive shorter courses of radiation with increased radiation doses per fraction had similar outcomes as patients who received longer courses of lower-dose per fraction radiation, a recent study suggests.

Researchers found no difference in breast pain, functional status, and cosmetic evaluations between treatments, according to a report published in Cancer. These findings could potentially lead to shorter and more convenient treatments as the suggested option for breast cancer patients.

Typically, patients with breast cancer are treated with conventionally fractionated whole-breast irradiation (CF-WBI), the longer treatment, as opposed to the shorter hypofractionated whole-breast irradiation (HF-WBI).

Previous trials have established HF-WBI as a safe and effective treatment for patients with breast cancer. The researchers also previously found this treatment can decrease acute toxicity and post-radiation fatigue compared with CF-WBI.

Although the benefits of HF-WBI have been shown, only about one-third of patients in the United States eligible to receive this treatment, according to the study.

"This trial is particularly important because there is still some hesitation among clinicians in the US about adopting the hypofractionated schedule," said lead author Cameron Swanick, MD. "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."

The study included 287 patients with early-stage (0 to 2) breast cancer who were at least 40 years old and had already had breast-conserving surgery. There were 149 patients who received CF-WBI treatment and 138 patients received HF-WBI treatment.

Patients also received another treatment that targeted the tumor with a higher dose, according to the study. Researchers gathered patient-reported outcomes (PROs) about cosmetics, functionality, and quality-of-life.

"There were no significant differences between the treatment arms for any PROs at baseline, six months, one year or three years," Dr Swanick said. "At 2 years, outcomes from the Functional Assessment of Cancer Therapy Breast trial outcome index were modestly higher in the hypofractionated group."

Researchers also found no large differences in physician-reported cosmetic scores. Patients reported decreased breast pain and improved function in both groups.

Since there were no differences in survival observed, researchers believe these findings and the findings of previous studies suggest that HF-WBI should be the preferred treatment for early-stage breast cancer, according to the study.