NEW ORLEANSA 3-week radiation schedule after lumpectomy is as
effective as the standard 5-week schedule in terms of local control,
overall survival, and cosmetic outcomes, Canadian researchers
reported in a plenary presentation at the 36th Annual
Meeting of the American Society of Clinical Oncology (ASCO).
Timothy Whelan, MD, of the Hamilton Regional Cancer Centre, Hamilton,
Ontario, Canada, said that the shorter schedule lessens the burden of
therapy for the patient, and shortens the length of the treatment
period by almost half for women with node-negative breast cancer.
The Canadian trial compared a shortened radiotherapy schedule of 42.5
Gy in 16 fractions in 22 days (arm A, n = 622) to a conventional
schedule of 50 Gy in 25 fractions in 35 days (arm B, n = 612). All
treatments were delivered daily Monday to Friday. Patients received
no regional nodal irradiation and no boost irradiation.
The trial included women with node-negative breast cancer with clear
resection margins following lumpectomy.
Cosmetic outcome was assessed at baseline, 3, and 5 years by a
trained nurse using a modified version of the European Organization
for Research and Treatment of Cancer (EORTC) Cosmetic Rating System.
No Significant Differences
At median follow-up of 5 years, 15 local breast recurrences were
reported in arm A and 22 in arm B. The corresponding 5-year actuarial
local breast recurrence rates are 2.5% for arm A and 3.3% for arm B.
No significant differences were seen in either distant recurrences or
deaths between the two arms (see Table 1).
Cosmetic Outcome Equivalent
Dr. Whelan also reported that there were no significant differences
in disease-free survival or overall survival, and that cosmetic
outcomean indicator of late morbidity following radiation
therapywas equivalent on both treatment arms (see Table 2).
The radiation schedule of 42.5 Gy in 16 fractions is as good as
50 Gy in 25 fractions in preventing local recurrence and producing a
good cosmetic result, Dr. Whelan commented. The shorter
schedule would also allow almost 50% more patients to be treated with
Despite the good results with shorter radiation therapy in this
trial, medical oncologists in the United States will await the long-term
results from this study and from the UK START trial of
increased radiation fraction size before changing their
practice, commented discussant Jay Harris, MD, of Brigham and
Womens Hospital, Boston, Massachusetts. This is due to
concern about long-term side effects, he added.
Late side effects such as brachial plexopathy and myocardial
infarction are typically seen more than 5 years after treatment, Dr.
Another concern is the deterioration in cosmetic result that may
occur beyond 5 years after irradiation. With lower radiation
doses, this deterioration stabilizes at 3 to 5 years after treatment,
but this may not be true with larger doses, he said.