Shorter Radiation For Breast Cancer Has Fewer Side Effects

Women diagnosed with early-stage breast cancer treated with a shorter whole-breast radiation schedule after lumpectomy have fewer side effects and better quality of life than women treated with the longer, traditional radiation schedule.

Two studies, published in JAMA Oncology, have found that women diagnosed with early-stage breast cancer treated with a shorter whole-breast radiation schedule after lumpectomy have fewer side effects and better quality of life than women treated with the longer, traditional radiation schedule.  Doctors have studied a new radiation therapy schedule called hypofractionated whole-breast radiation. It involves fewer treatments with higher doses of radiation at each treatment but the same total radiation dose. 

Women must meet the following four criteria:

1. Age 50 or older when diagnosed

2. Cancer is stage T1 or T2, no cancer cells have been found in the lymph nodes and the cancer has been removed with lumpectomy

3. Cancer hasn’t been treated with chemotherapy

4. The minimum and maximum doses of radiation are plus or minus 7% of the prescription dose

The two JAMA Oncology studies were different types.  One was a randomized study, which means the researchers randomly assigned women to a treatment group.  The other study was an observational study, which means the researchers looked at the records of women after treatment was done to see any differences in outcomes.

In the randomized study, researchers randomly assigned 287 women diagnosed with DCIS (stage 0), Stages I or II breast cancer who had had lumpectomy.  149 women received conventional whole-breast radiation and 138 women received hypofractionated whole-breast radiation. The women on the hypofractionated radiation schedule had fewer side effects.  Overall, 47% had one or more side effects compared to 78% of the conventional group.

In the observational study, the researchers looked at the records of 2309 women diagnosed with early-stage breast cancer who had lumpectomy and then whole-breast radiation after surgery from October 2011 to June 2014.  578 received hypofractionated radiation and 1731 received conventional radiation. There were fewer side effects in women treated with hypofractionated radiation. 

Researchers recommend that these findings should be communicated to patients when making their decisions about radiation therapy.

Despite these results and recommendations, fewer than 33% of women eligible receive hypofractionated radiation because they are concerned about side effects when compressing the same radiation dose.

Since side effects and quality of life are very important for women in making a decision between treatments, doctors should offer these two options and all other options available.