Shortened Radiation Treatment Works for Breast Cancer

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Radiation therapy is often used in conjunction with breast conservation surgery in treatment of breast cancer. Conventional radiation therapy is a 5-week regimen which up to 30% of women may avoid due to inconvenience and cost.

Researchers have begun to look at using shorter regimens, and are finding that the 10-year recurrence rates and cosmetic outcomes for breast cancer patients are similar.

The latest study to add to this subject comes out of Canada and is published in the February 11 issue of of the New England Journal of Medicine.

Dr. Tim Whelan, a professor of oncology of the Michael G. DeGroote School of Medicine at McMaster University, and colleagues compared an intense three-week course of hypofractionated radiation therapy to the standard five-week regimen for women with early-stage breast cancer.

The study included 1234 women with invasive breast cancer who had undergone breast-conserving surgery, had clear resesection margins were clear, and negative axillary lymph nodes. The women were randomly assigned to receive whole-breast irradiation either at a standard dose of 50.0 Gy in 25 fractions over a period of 35 days (the control group) or at a dose of 42.5 Gy in 16 fractions over a period of 22 days (the hypofractionated-radiation group).

The risk of local recurrence at 10 years was found to be similar in both groups: 6.7% among the standard irradiation group compared with 6.2% among the hypofractionated group.

The cosmetic outcome for both groups was found to be similar at 10 years: 71.3% of the control group as compared with 69.8% of the hypofractionated-radiation group had a good or excellent cosmetic outcome.

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In the study, there were no cases of grade 4 skin ulceration or soft-tissue necrosis occurred in either group.

Radiation treatment given to the breast does not result in nausea or hair loss on the head. Most patients develop mild fatigue that builds up gradually over the course of therapy. This slowly goes away one to two months following the radiation therapy.

The most common side effect needing attention is skin reaction. Most patients develop reddening, dryness and itching of the skin after a few weeks. Some patients develop substantial irritation.

Some patients develop a sunburn-like reaction with blistering and peeling of the skin, called "moist desquamation," most often in the fold under the breast or in the fold between the breast and the arm. Most people with a limited area of moist desquamation can continue treatment without interruption. Skin reactions usually heal completely within a few weeks of completing radiotherapy

Skin care recommendations include:

  1. Keeping the skin clean and dry using warm water and gentle soap
  2. Avoiding extreme temperatures while bathing
  3. Avoiding trauma to the skin and sun exposure (use a sunscreen with at least SPF 30)
  4. Avoiding shaving the treatment area with a razor blade (use an electric razor if necessary)
  5. Avoiding use of perfumes, cosmetics, after-shave or deodorants in the treatment area (use cornstarch with or without baking soda in place of deodorants)
  6. Using only recommended unscented creams or lotions after daily treatment.

Source reference:
Whelan TJ, et al "Long-term results of hypofractionated radiation therapy for breast cancer" N Engl J Med 2010; 362: 513-20.

American Cancer Society

Radiology Info

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Comments

This is an interesting development in the treatment of breast cancer. The outcome of the study may convince more women, who avoid radiation therapy due to its high cost or inconvenience, to undergo shorter, more intense regimens of it. Since skin problems such as soreness, itching, peeling, etc. are common side effects of radiation therapy, the author has shared some great tips on skin care. Radiation Therapy