Published: 29 April 2020
Women with early stage breast cancer can be treated with fewer but larger daily doses of radiotherapy delivered in a shorter overall duration compared with the current standard, finds research funded and supported by NIHR.
The pioneering study involving more than 4,000 patients, evaluated the effectiveness of two different radiotherapy doses each delivered over five days in one week compared with standard radiotherapy currently delivered in 15 doses over three weeks.
The researchers, led by a team at The Institute of Cancer Research, London, found that delivering a shorter course to women who have undergone surgery for early stage breast cancer was as safe and effective as the standard of three weeks - reducing treatment times while saving precious healthcare resources.
Now results of the FAST-Forward trial have been published in The Lancet.
The phase III randomised clinical trial involved patients from 97 NHS hospitals in the UK. It 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 ICR.
Professor Murray Brunt, the study’s Chief Investigator from the University Hospitals of North Midlands and University of Keele, said: “This landmark trial reveals that a one-week schedule promises to become a new international standard for women with operable breast cancer requiring radiotherapy. This has major benefits in terms of convenience and costs for both patients and healthcare services globally at a time when they face increasing challenges.”
Professor Nick Lemoine, Medical Director of the NIHR Clinical Research Network (CRN), said: “Breast cancer is the most common cancer amongst women and the largest user of radiotherapy facilities in the UK.
“NIHR is committed to funding practice-changing research and this landmark study supports that position. This study shows how innovation can be both clinical and cost-effective and it’s an important marker for broader impact of healthcare treatments and tests for those who plan, provide or receive care from NHS and social care services.”
Breast cancer is the most common cancer affecting women worldwide. There are around 55,200 of new cases annually in the UK – around 150 a day. Historically women received radiotherapy in 25 daily doses (‘fractions’) over five weeks. This was reduced to a standard of 15 daily doses in three weeks over 10 years ago.
In this latest study a third of participants received 15 daily doses amounting to a total overall dose of 40 Gy (Gray, or Gy = unit of radiation dose) in three weeks. The remaining patients were split into two groups, each receiving five daily treatments in one week, with a total dose of either 26 Gy or 27 Gy.
Five years after radiotherapy, the risk of cancer coming back in the same breast was very low and similar between all three treatment groups. Long-term side effects were similar after the 26 Gy one-week schedule compared with the standard three-week schedule.
Reducing standard radiotherapy treatment for breast cancer from three weeks to one week would save the NHS over £40 million per year, researchers say.
Professor Judith Bliss, Professor of Clinical Trials at ICR London, and Director of its Clinical Trials and Statistics Unit, and joint senior author of the study, said: “We expect these findings will be incorporated into breast cancer treatment guidelines around the world and we’re already seeing NHS hospitals wanting to move to the 5-dose schedule because of the challenges they’re facing during the coronavirus pandemic.”
Fast-Forward: a randomised clinical trial testing a 1-week course of curative whole breast radiotherapy against a standard 3-week schedule in terms of local cancer control and late adverse effects in women with early breast cancer