Ten-year study confirms long-term safety of larger radiation doses for breast cancer

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Ten-year study confirms long-term safety of larger radiation doses for breast cancer

by John R. Fischer, Senior Reporter | July 17, 2020
Rad Oncology

Moderate or severe long-term effects were low across the treatment groups, with 86% of women experiencing no changes or minor changes in their healthy breast tissue after 10 years. The most common effect was breast shrinkage. Moderate or marked effects were two thirds more likely to occur in women on the 30 Gy regimen than those with the 50 Gy. Women on the 28.5 Gy regimen had a similar risk of moderate or marked effects to those on the 50 Gy.

Researchers concluded that using 28.5 Gy in five fractions once a week is safe in the long-term for certain patients, such as those who are frail or have chronic conditions.

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“Our findings support treatment options that are more convenient for patients who cannot tolerate long courses of daily radiation, without increasing the risk of long-term side effects,” professor John Yarnold, chief investigator of the FAST trial, professor of clinical oncology at the ICR, and honorary consultant at the Royal Marsden NHS Foundation Trust, said in a statement. “The FAST trial confirms the safety of a radiotherapy course consisting of a lower total dose of radiotherapy delivered in five fractions of radiation. FAST has also laid the groundwork for the FAST-Forward trial, testing an even shorter treatment course of five fractions of breast radiotherapy delivered in a single week, which is likely to become a U.K. standard for patients with early breast cancer.”

FAST-Forward is a phase three, multicenter, randomized controlled trial that seeks to evaluate the effectiveness and safety of delivering five fractions of radiotherapy daily for one week, instead of the current U.K. standard of administering 15 fractions after primary surgery for early-stage breast cancer.

The FAST trial has already made an impact in not just the U.K. but the international stage as well, according to Somaiah. "This trial has already had a major impact both in the U.K. and internationally. Normally trials go through NICE approval before national guidelines are changed. However, the unprecedented circumstances in relation to COVID-19, have led to rapid adoption of this treatment schedule in order to safely treat breast cancer patients during the pandemic. The expectation is that this will become standard of care for early breast cancer patients in the very near future.”

The 10-year results of the FAST trial were funded by Cancer Research UK.

The results were published in the Journal of Clinical Oncology.

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