Published: 04 February 2021
The results of the FAST-Forward trial came in the nick of time last year. Professor Jon Wadsley, NIHR National Specialty Lead for Radiotherapy and Imaging, writes about the importance of radiotherapy research on World Cancer Day.
The COVID-19 pandemic has created unprecedented challenges for the NHS, not just in terms of caring for patients affected by a novel and potentially fatal virus, but also in continuing to treat patients with other conditions such as cancer whilst ensuring their safety.
Radiotherapy treatment usually requires multiple visits to hospital, typically five days a week for three to seven weeks. At the onset of the pandemic there were major concerns about the safety of bringing potentially vulnerable patients into hospital for so many visits, and the capacity within radiotherapy departments to continue delivering treatments due to staff sickness or having to isolate.
Prior to the pandemic, patients with early breast cancer were frequently recommended to undergo a course of 15 radiotherapy treatments over three weeks to reduce the risk of cancer recurrence. The aim of the FAST-Forward trial was to test whether a course of five treatments over one week was as safe and effective.
4,100 patients had been recruited to the trial from 97 UK hospitals over 2.5 years, each allocated to one of three treatment groups - the standard 15 treatment schedule or one of two, five treatment schedules, delivering slightly different total doses. Patients in all groups were carefully followed up to check for any evidence of cancer recurrence and for any late side effects from the treatment.
One week was just as safe and effective
The results of the trial became available just as the COVID-19 pandemic hit last year. These showed that at five years after radiotherapy treatment, results were very similar in terms of cancer recurrence, which was very low in all groups, and both short term and longer term side effects for the five and 15 treatment schedules. These results were rapidly published in The Lancet in May.
Since many UK radiotherapy centres had participated in the trial, they were already familiar with delivering the new five treatment schedule and this was therefore rapidly implemented in many departments. To help centres who had not participated, the trial team made the protocol and radiotherapy planning guidance documents available ahead of publication. This meant that patients with breast cancer could continue to receive safe and effective treatment in a significantly reduced number of visits to hospital. Since breast cancer is so common and accounts for a large proportion of a radiotherapy department’s workload, this reduction from 15 to five treatments per patient also released capacity to ensure that patients with other cancers could continue to be treated safely.
The FAST-Forward trial is just one example of a large number of UK led radiotherapy trials which have influenced both UK and international practice in recent years, often resulting in more convenient treatment schedules for patients.
The Standardisation of Breast Radiotherapy (START) B Trial, funded by Cancer Research UK, Medical Research Council and Department of Health and Social Care, had previously shown that breast cancer radiotherapy could be given in 15 rather than 25 treatments resulting in this becoming the UK standard of care and therefore the control arm of the FAST-Forward trial.
In prostate cancer, studies have shown that 20 treatments delivered over four weeks is as effective as 37 treatments delivered over 7.5 weeks. Ongoing studies are investigating the possibility of reducing this further to five treatments over one week. These studies will bring far reaching benefits to patients long after the COVID-19 pandemic is behind us.
It has been an exciting time to be involved in radiotherapy research. In recent years I have witnessed huge progress in more accurately targeted treatment using novel treatment techniques, as well as increased convenience from reducing the number of individual treatment visits required. It is vitally important that these new techniques are implemented in a safe and controlled fashion, and scientifically tested through clinical trials, to ensure that they really do bring added benefit to patients and the health service.
Resilience of cancer research
At the onset of the pandemic most radiotherapy research was put on hold due to concerns for patient safety and the redeployment of many research staff to cope with the delivery of routine clinical services. While some cancer research, including radiotherapy studies, has restarted, some has not and NIHR and NHS England and NHS Improvement are absolutely committed to restarting the studies that remain on hold, and ensuring the resilience of research delivery in the future. I believe that this is crucial to allow us to continue to improve outcomes for patients and deliver treatment in the most efficient schedules for the sustainability of the health service, as has been demonstrated by the FAST-Forward trial.
Professor Jon Wadsley, Consultant Clinical Oncologist, NIHR National Specialty Lead Radiotherapy and Imaging
Results from the FAST-Forward trial reveal women with early stage breast cancer can be treated with fewer but larger daily doses of radiotherapy delivered in one week compared to the current standard of three weeks. Read more about the study on the NIHR website:
- One-week course of radiotherapy could benefit women with early stage breast cancer
- How taking part in research helped me get my life back on track and overcome cancer
The study was funded by NIHR’s Health Technology Assessment (HTA) Programme and supported by the NIHR Clinical Research Network (CRN) and by the NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research. It was led by researchers at the Institute of Cancer Research, London.
For more information on getting involved in research visit the Be Part of Research website.