Is 1-Week of Radiation Treatment as Effective as Extended Radiation for Early-Stage Breast Cancer?

In the landscape of female health, breast cancer stands as the second most prevalent diagnosed cancer in the United States, affecting women profoundly. The conventional approach to radiation therapy demands frequent hospital visits, spanning over 4–6 weeks, with a stringent regimen of five days per week.

However, a recent groundbreaking study revolutionizes this norm, unveiling a safe and efficient alternative: condensing the entire radiation therapy into a mere week, a stark departure from the established three-week standard. This transformative randomized trial, hailing from the esteemed medical realm of the United Kingdom and documented in The Lancet, a pinnacle in Oncology, not only validates the feasibility of this abbreviated schedule but also emphasizes its potential to ameliorate patients' quality of life by circumventing heightened side effects.

1-Week Treatment vs. 3-Week Radiation Treatment: Know the Significance

After undergoing breast cancer surgery, patients typically undergo radiation therapy to diminish the likelihood of cancer recurrence. Traditionally, this involved a five-week course of daily treatments, a regimen that drastically changed in March 2018 when the American Society for Radiation Oncology (ASTRO) shifted gears, recommending a condensed three-week whole breast radiation therapy instead. This shift stemmed from extensive trials conducted across the United Kingdom and North America demonstrating comparable safety and effectiveness between the three and five-week treatment periods.

The UK has led the charge in advocating for shorter radiation therapy durations for breast cancer. Initial strides in this direction were made through comprehensive randomized clinical trials comparing the efficacy of five-week and three-week radiation therapy courses. The outcomes, published in The Lancet on September 19, 2013, under the title “The UK Standardization of Breast Radiotherapy (START) Trials for Radiotherapy Hypofractionation for Treatment of Early Breast Cancer: 10-year Follow-up Results of two Randomized Controlled Trials,” unequivocally supported the safety and efficacy of the shorter three-week regimen for early-stage breast cancer. These findings prompted ASTRO's revision of their guidelines in 2018, urging American radiation oncologists to adopt the shorter course as the new standard of care.

Despite the progress, the inconvenience and difficulty of adhering to a three-week daily radiation therapy regimen persist for many patients. Enter the United Kingdom's innovative approach yet again, this time pioneering an ultra-short, one-week whole breast radiation therapy known as the FAST-Forward regimen. The extensive FAST-Forward clinical trial, involving 4,096 women with early-stage breast cancer who had undergone tumor removal, compared the efficacy and potential side effects of one week versus three weeks of radiation therapy. The five-year monitoring period post-treatment aimed to assess recurrence rates and potential adverse effects.

Published on May 23rd, 2020, in The Lancet under the title “Hypofractionated breast radiotherapy for one week versus three weeks (FAST-Forward): Five-year efficacy and late normal tissue effects results from a multicenter, non-inferiority, randomized, phase 3 trial,” the study unveiled compelling results. At the five-year mark, only 1.4% of patients subjected to the one-week course experienced cancer recurrence, while the three-week course exhibited a slightly higher rate at 2.1%. This pointed to both schedules yielding comparable and equally effective reductions in recurrence risk.

Beyond recurrence rates, the study also scrutinized side effects. In the one-week course, 11.9% of women reported skin-related side effects compared to 9.9% in the three-week course. However, this difference, though existent, held no clinical or statistical significance, implying an equivalent risk of skin-related side effects between both radiation treatment schedules. Ultimately, the research concluded that the one-week radiotherapy schedule proved as safe and effective as the established international three-week regimen for early breast cancer. Notably, the authors highlighted the substantial convenience and cost benefits of the one-week schedule for patients and global healthcare services.

What Does This Recent Research Study Mean for You?

The groundbreaking findings from the FAST-Forward study paint an optimistic picture, showcasing an equivalence between one-week and three-week treatments regarding cancer recurrence risk and side effects. However, a crucial caveat lies in the study's limitation: it merely unveils findings from a five-year follow-up.

Numerous UK radiation centers engaged in the trial, facilitating swift adoption of this novel treatment schedule across the country. The onset of the COVID-19 pandemic further accelerated the integration of the one-week regimen by radiation oncologists, aiming to minimize patient visits to radiation facilities. American institutions mirrored this trend during the pandemic, embracing the condensed one-week approach.

Radiation treatment for breast cancer has undergone rapid evolution within this decade, compressing five weeks of therapy to three in 2018 and now further condensing it to a mere week in 2021. The advent of this ultra-convenient, cost-effective, and abbreviated radiation therapy heralds a likely permanence in the treatment landscape.

Equivalent Safety and Effectiveness

The resounding significance of the FAST-Forward clinical trial cannot be overstated, affirming the capacity of both shorter and longer early-stage breast cancer radiotherapy courses to curtail cancer recurrence.

Economic Efficacy

Opting for one-week radiotherapy entails fewer fractions compared to the customary three-week course—5 fractions over 1 week versus 15 over 3 weeks—resulting in cost reduction and diminished financial strain while preserving the benefits of the expensive, extended treatment.

Enhanced Convenience

Fewer radiotherapy sessions translate to fewer hospital trips, amplifying convenience by minimizing patient travel and freeing up more personal time.

The paradigm shift toward condensed radiotherapy regimens not only underscores their efficacy but also promises economic relief and heightened convenience for patients navigating the intricate landscape of cancer treatment.

Final Thoughts

Are you or your loved ones diagnosed with breast cancer and radiation therapy is recommended as part of the treatment plan? Visit Sierra Hematology & Oncology and make sure to ask our radiation oncologist about the FAST-Forward study. Enquire whether this one-week radiation for breast cancer makes sense for you or your loved ones’ unique condition.

References

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30932-6/fulltext

https://pubmed.ncbi.nlm.nih.gov/29545124/