The study reviewed here 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.
The two British studies reviewed here, called START A and START B, compared the benefits and risks of the standard radiation therapy schedule to three low-dose schedules:
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:
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 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.
About 40% of women in two large breast cancer radiotherapy trials reported being concerned about some aspect of body image over the five years following therapy, researchers said.
But there was little difference between those in the standard therapy arms and those getting so-called hypofractionated regimens, according to Penelope Hopwood, MD, of the Institute of Cancer Research in Sutton, England, and colleagues.
The finding is evidence that a lower overall radiation dose given in fewer but larger fractions does not increase adverse effects or worsen body image for most women, Hopwood and colleagues said online in The Lancet Oncology.
The researchers used data from quality-of-life substudies from the two randomized Standardisation of Breast Radiotherapy (START) trials, conducted concurrently in the U.K.
The Start A trial compared a standard regimen -- 50 gray (Gy) delivered in five 2.0-Gy fractions weekly over five weeks -- with two hypofractionated regimens.
In the first test regimen, women were treated with 41.6 Gy in 13 fractions of 3.2 each over five weeks, with three fractions in one week and two the next. The other regimen followed the same schedule, but delivered 39 Gy in 13 fractions of 3.0 each.
The Start B study was a noninferiority trial comparing the standard regimen with one that delivered 40 Gy in 15 fractions of 2.67 each over three weeks. In contrast to Start A, both regimens had five fractions per week.
As part of the studies, the researchers enrolled 2,208 participants in a quality-of-life analysis that looked at adverse events and changes in body image over a five-year follow-up period.
They found:
Overall, the findings "strengthen evidence in favor of hypofractionated regimens, with a potential for fewer adverse effects on the normal breast tissues," the researchers concluded.
The study's findings "provide a strong foundation" for more research into how patients experience radiotherapy, according to Julie Schnur, PhD, of Mount Sinai School of Medicine in New York City.
Among areas that might be examined, she wrote in an accompanying editorial, are:
Schnur said the researchers showed "a consideration of the patient's point of view that is too often absent."
The study had support from Cancer Research UK, the U.K. Medical Research Council, and the U.K. Department of Health.
The authors declared no conflicts of interest.
Primary source: The Lancet Oncology Source reference: Hopwood P, et al "Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials" Lancet Oncol 2010; DOI: 10.1016/S1470-2045(09)70382-1.Additional source: The Lancet OncologySource reference: Schnur, JB "Radiotherapy-induced skin changes and quality of life" Lancet Oncol 2010; DOI: 10.1016/S1470-2045(10)70004-8.
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