Side Effects, Body Image Concerns Same for Standard and Lower-Dose Radiation Schedules

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A study compared a standard radiation therapy schedule to new, lower-dose schedules and found that side effects and body image concerns were about the same for all the schedules.

After lumpectomy, radiation therapy often is used to reduce the risk of the cancer coming back (recurrence). Radiation therapy after breast cancer surgery usually is given as 25 treatments -- you're treated 5 times per week for 5 weeks. A Gray is the way radiation oncologists measure the dose of radiation therapy; 50 Gray is the usual amount given during the 5 weeks.

Doctors have been studying new radiation therapy schedules that involve fewer treatments with higher doses of radiation given at each treatment, but less total radiation. These new schedules are called "low dose" or "hypofractionated" radiation therapy. The low-dose schedules are thought to be more convenient than standard radiation therapy -- radiation treatment takes fewer treatment days or a shorter period of time (or both). Research suggests these low-dose schedules may be as effective as the standard schedule.

Two British studies, called START A and START B, compared the benefits and risks of the standard radiation therapy schedule to three low-dose schedules:

  • 41.6 Gray total: 3.2 Gray at each treatment, given at three treatments in one week and two treatments the next week, over 5 weeks, for a total of 13 treatments
  • 39 Gray total -- 3.0 Gray at each treatment, given at three treatments in one week and two treatments the next week, over 5 weeks, for a total of 13 treatments
  • 40 Gray total -- 2.7 Gray at each treatment, given at five treatments each week, over 3 weeks, for a total of 15 treatments

The researchers found that 40% of the women in the studies had concerns about their overall body image or changes to their bodies due to the radiation therapy in the 5 years after treatment:

  • 41% of the women were bothered by breast hardness
  • 39% of the women were bothered by a change in overall breast appearance

The researchers wanted to know if there were differences in side effects and concerns about body image based on the radiation therapy schedule a woman received, so they analyzed results from more than 2,200 women.

Overall, there wasn't much difference in the likelihood of side effects or concerns about body image related to the different radiation therapy schedules:

  • The women who got the two lowest-dose schedules (39 Gray or 40 Gray total) were somewhat less likely to have side effects or body image concerns, but the difference wasn't significant and may have been due to chance and not because of the different schedules.
  • Side effects and body image concerns were less likely as time passed for all the women in the study, no matter which treatment schedule they got.

The results suggest that the risk of side effects and body image concerns are the same for both low-dose and standard radiation schedules. The low-dose schedules are appealing because radiation therapy is completed in fewer treatment days or over a shorter period of time. Scheduling daily trips to get radiation therapy treatment can be a problem for some women, so the low-dose schedules may be easier for them. The research is promising and some doctors (particularly in Canada) already are using low-dose schedules. Still, more research is needed before doctors are completely confident that low-dose schedules are as effective as the standard schedule.

If radiation therapy is part of your treatment plan, you might want to talk to your doctor about low-dose radiation therapy schedules and whether one makes sense for you based on your unique situation and specific scheduling needs.

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