Following Reconstruction, Patients With Early Breast Cancer May Safely Opt For a Shorter Course of Radiation Therapy

Patients with early-stage breast cancer may be able to opt for 3 weeks of hypofractionated radiation therapy instead of 5 weeks of conventional radiation therapy without compromising efficacy outcomes, according to findings from the FABREC study, which were presented at the American Society for Radiation Oncology Annual Meeting.^1,2

Rinaa S. Punglia, MD, MPH

At a median follow-up of 40.4 months, there were no differences in terms of death, local or distant recurrence between patients who underwent either length of radiation therapy. No differences in toxicity were identified either (P = .80).

Further, the patient-reported outcomes were similar between the 2 groups, with a small but statistically significant benefit for those under 45 who received short-course radiation (P = .70).

“Our trial results suggest that hypofractionation can safely be used in this setting without compromising efficacy or increasing side effects,” Rinaa S. Punglia, MD, MPH, a radiation oncologist at Dana-Farber Brigham Cancer Center, said in a press release. “Reducing the requirement to 3 weeks of radiation therapy would be a significant improvement in the quality of our patients’ lives.”

Benefits of Hypofractionation Radiation Therapy

Reducing the length of radiation time may positively impact patient quality of life by significantly reducing life disruption and financial burden for these patients.

As with most cancer populations, many patients in this study (n = 51) needed to take time off of work. The study showed that for patients who underwent conventional therapy, the mean amount of time off was 125.8 hours. In comparison, for patients who underwent hypofractionated radiation therapy, the mean amount of time off was 73.7 hours (P = .046).

Some patients in the study who underwent conventional therapy shared that they would have preferred 3 weeks and the flexibility it could have afforded them.One patient shared that, besides scheduling appointments, “the hardest thing about radiation was the time it took to do it.” Another shared, “I live far, so coming in for daily radiation for over 5 weeks meant missing significant life events. I missed my kids first day of school. I would have wanted short-course radiation had it been an option. It is time you don’t get back.”

Study Methodology

This study included 400 patients with stage 0-III breast cancer who had already undergone immediate implant-based reconstruction. Enrollment took place between March of 2018 and November of 2021. The median patient age was 47.0 years (range, 23-79) and the median time from surgery to radiation therapy was 2.6 months.

Participants were randomly assigned 1:1 to undergo either conventional or hypofractionated radiotherapy. Conventional therapy was comprised of 25 fractions of 200 cGy. Hypofractionated therapy was comprised of 16 fractions of 266 cGy. Physical well-being at 6 months was the primary endpoint.

A Unique Patient Population

According to the investigators, this trial represents the first to compare 3 weeks of radiation to a 5-week course in patients who have undergone both mastectomy and reconstruction.

Julia S. Wong, MD

To reduce the chance of breast cancer recurrence, many patients with breast cancer choose to undergo a mastectomy. For about 1 out of 3 patients who choose to undergo a mastectomy, radiation therapy is also recommended. However, as more women choose to pursue implant-based reconstruction, radiation therapy becomes riskier. Postreconstruction, radiation increases the risks of infection and cosmetic changes, such as the formation of scar tissue around the breast—which can result in hardness and asymmetry.

“We know that radiation can cause unwanted changes to cosmetic results in patients who have mastectomy and reconstruction,” Julia S. Wong, MD, a radiation oncologist at Dana-Farber Brigham Cancer Center, added in the press release. “With this trial, we were looking for a way to improve quality of life and cosmetic results without sacrificing efficacy.”

References

1. Shorter course of radiation therapy is safe for patients with early-stage breast cancer who have undergone mastectomy and reconstruction. News release. Dana-Farber Cancer Institute. October 1, 2023. Accessed October 3, 2023. https://www.dana-farber.org/newsroom/news-releases/2023/shorter-course-of-radiation-therapy-is-safe-for-patients-with-early-stage-breast-cancer-
2. Wong JS, Uno H, Tramonto A. Patient-reported and toxicity results from the FABREC study: A multicenter randomized trial of hypofractionated vs. conventionally fractionated postmastectomy radiation therapy after implant-based reconstruction. Presented at: ASTRO 2023. October 1-4, 2023; virtual.