Radiotherapy schedules in women with invasive breast cancer can be greatly simplified

If the findings of our trial are confirmed by further research, it is likely that prescribing practices will start to change, certainly in the
UK. It will also allow a change from traditional methods of adjusting dose intensity, whereby 25 fractions are delivered to the whole breast followed by a further 8 fractions to the region of the breast where the breast cancer used to be i.e. a total of 33 doses or fractions delivered by a shrinking field technique. It will make more sense to fix the number of fractions and adjust the fraction size across the breast, delivering smaller sized fractions to low risk areas and larger fractions to higher risk ones. This approach is due to be tested in the UK IMPORT HIGH trial starting in early 2007. Meawhile, the results of the UK START trial (N=4451) testing larger fraction sizes are awaited, and the UK FAST trial evaluating 5 versus 25 fractions over 5 weeks is testing the limits of this approach.

Bibliographical reference:

Owen JR et al.: "Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial", Lancet Oncology 2006; 7:467-471

John Yarnold

Department of Radiotherapy, Royal Marsden Hospital, Sutton, UK