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STUDY: A shorter course of radiation therapy (RT) achieved the same results as the longer
JOURNAL: J Natl Cancer Inst. 2002;94(15): 1114-1115, 1143-1150
AUTHORS: Timothy Whelan
ABSTRACT: A shorter course of radiation therapy (RT) achieved the same results as the longer, now standard, course of RT for women with clean margins at the time of lumpectomy for breast cancer, according to the results of a randomized trial published in the Journal of the National Cancer Institute.
COMMENTARY: "A shorter fractionation schedule will lessen the burden of treatment for women, many of whom may also receive adjuvant chemotherapy, and will have important quality-of-life benefits with respect to convenience and less time away from home and work," write Timothy Whelan, BM, BCh, MSc, from the Hamilton Regional Cancer Centre in Ontario, Canada, and colleagues.
In this study, 1,234 women who had undergone lumpectomy for invasive breast cancers without lymph node metastases were randomized to receive either a shorter or longer course of whole breast radiation. The fractionation schedule was 42.5 Gy in 16 fractions over 22 days in the short treatment group, or 50 Gy in 25 fractions over 35 days in the long treatment group. Median follow-up was 59 months.
At five years, local recurrence-free survival was 97.2% in the short group and 96.8% in the long group (absolute difference, 0.4%; 95% confidence interval, -1.5% to 2.4%). There was no difference in disease-free or overall survival. The proportion of patients with excellent or good global cosmetic outcome was similar in both groups, and was greater than 76% at three years and at five years.
In an accompanying editorial, Carolyn I. Sartor, MD, and Joel E. Tepper, MD, of the University of North Carolina School of Medicine in Chapel Hill, ask whether this study sets a new standard for adjuvant radiation for early-stage breast cancer. Newer technologies such as brachytherapy may allow even more convenient, less invasive therapies without compromising long-term outcome.
However, they caution against extrapolating the good outcomes in this study beyond a select group with small tumors completely resected with clean margins.
"In carefully selected patients, use of shorter, less expensive, and more convenient radiotherapeutic approaches can produce excellent local control of breast cancer with acceptable cosmesis," they write. "It is premature to generalize these results beyond the categories of patients actually treated in the trial, but, with further technologic and biologic advances, perhaps we can ultimately do even 'less.' "