Shorter-course radiation ‘preferred approach’ for breast cancer
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Key takeaways:
- Survival and recurrence rates appeared similar between patients who received hypofractionation and conventional fractionation.
- Hypofractionation reduced risk for adverse events and improved quality of life.
Hypofractionated radiation therapy after breast cancer surgery significantly reduced risk for adverse events and improved quality of life compared with a conventional radiation therapy schedule, according to study results.
Researchers observed no meaningful difference in survival or recurrence rates based on radiation schedule.
“Our study corroborates the efficacy of moderate hypofractionation in radiation therapy for breast cancer, highlighting additional benefits including reduced side effects, increased convenience and potential cost-effectiveness,” Shing Fung Lee, MBBS. MSc, associate consultant in the department of radiation oncology at National University Cancer Institute in Singapore, and researchers wrote. “These findings justify the wider adoption of moderate hypofractionation as the preferred approach, given its balance of therapeutic efficacy and improved safety.”
Lee and colleagues conducted a systematic review and meta-analysis of randomized controlled trials that focused on various fractionation methods in radiation therapy for patients with breast cancer.
Investigators aimed to evaluate adverse effects, cosmesis, quality of life, survival and risks for recurrence associated with each method.
Researchers used Embase, Ovid MEDLINE and Cochrane Central Register of Controlled Trials to identify 59 articles that represented 35 trials with a combined 20,237 participants.
The trials included patients who received conventional fractionation (1.8 Gy to 2 Gy daily, reaching a total dose of 50 Gy to 50.4 Gy over 5 to 6 weeks), moderate hypofractionation (2.65 Gy to 3.3 Gy for 13 to 16 fractions over 3 to 5 weeks) or ultra-hypofractionation (five fractions).
Researchers pooled RRs and HRs with 95% confidence intervals using a random effects model.
Grade 2 or higher acute radiation dermatitis and late radiation therapy-related adverse events served as the prespecified outcomes. Secondary outcomes included cosmesis, quality of life, recurrence and survival.
RRs for grade 2 or higher acute radiation dermatitis after moderate hypofractionation vs. conventional fractionation were 0.54 (95% CI, 0.49-0.61) for patients who breast-conserving therapy and 0.68 (95% CI, 0.49-0.93) for those who underwent mastectomy.
Hyperpigmentation (RR = 0.77; 95% CI, 0.62–0.95) and grade 2 or worse breast shrinkage (RR = 0.92; 95% CI, 0.85-0.99) occurred less frequently after moderate hypofractionation than conventional fractionation.
However, among patients in breast-conserving therapy-only trials, the differences in hyperpigmentation (RR = 0.79; 95% CI, 0.6-1.03) and breast shrinkage (RR = 0.94; 95% CI, 0.83-1.07) did not reach statistical significance.
The RR for grade 2 or worse acute radiation dermatitis with ultra-hypofractionation compared with moderate hypofractionation was 0.85 (95% CI, 0.47-1.55) for all patients regardless of whether they received breast-conserving therapy or underwent mastectomy.
Moderate hypofractionation appeared associated with improved cosmesis and quality of life compared with conventional fractionation. Data on ultra-hypofractionation appeared less conclusive, researchers wrote.
Survival and recurrence outcomes appeared similar between those who received ultra-hypofractionation, moderate hypofractionation or conventional fractionation.
Researchers acknowledged study limitations, including the risk for bias. They determined 21.6% of studies included in the analysis had a low risk for bias, whereas 78.4% had some concerns or a high risk for bias.
In addition, not all outcomes — particularly related to cosmesis and adverse effects — had been reported in all trials.
References:
- Lee SF, et al. BMJ. 2024;doi:10.1136/bmj-2023-079089.
- Shorter-course radiation better option for breast cancer patients than conventional schedule (press release). Available at: https://bmjgroup.com/shorter-course-radiation-better-option-for-breast-cancer-patients-than-conventional-schedule/. Published Sept. 12, 2024. Accessed Oct. 2, 2024.
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Lee SF, et al. BMJ. 2024;doi:10.1136/bmj-2023-079089.
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