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Partial radiotherapy suitable for early breast cancer

Findings may change clinical practice globally

Jo Carlowe

Thursday, 10 March 2016

Partial radiotherapy cuts breast cancer treatment side effects and is just as effective as standard whole breast radiotherapy, new research shows.

Presenting the case at the 10th European Breast Cancer Conference, held this week in Amsterdam, Dr Charlotte Coles, Consultant Clinical Oncologist at Cambridge University Hospitals NHS Trust, said: “We’re really pleased we have demonstrated a very effective radiotherapy approach that also reduces the side effects of treatment. Minimising these long term side effects is essential, as not only do they impact on physical health, but they can also cause psychological distress.”

In the IMPORT LOW trial, a team of 30 radiotherapy centres led by The Institute of Cancer Research, London, studied more than 2,000 women aged 50 or over who had early breast cancer which was at low risk of coming back.

In the study,* women who had already had their tumours removed by breast conserving surgery were separated into three groups. One had full dose radiotherapy to the whole breast – the current standard treatment.

The second group, after surgery to remove their tumour, had the full dose of radiotherapy to the area the tumour had been in – with a lower dose to the rest of the whole breast.

The third group received the full dose to the area where the tumour had been, and were given no radiotherapy to the rest of the breast.

All three groups received 15 separate treatments over three weeks using a simple form of intensity modulated radiotherapy (IMRT).

Five years after their treatment, only 1% or less of women in each group had a recurrence of their cancer in their breast.

Patients also reported greater satisfaction with breast appearance, particularly with partial breast radiotherapy.

The researchers hope the trial results will contribute to changes in clinical practice worldwide. They also expect side effects to continue to be lower for women in the partial breast radiotherapy group after ten years, compared with those given the full dose of radiotherapy to the whole breast.

Professor Judith Bliss, study co-leader, director of the Cancer Research UK-funded clinical trials and statistics unit at The Institute of Cancer Research, London, said: “We hope that these important results will contribute to a change in practice in the very near future. The simple radiotherapy techniques used in this trial can be carried out on standard radiotherapy machines across the UK, so widespread implementation would be relatively straightforward.”

Conference chair, Professor Fatima Cardoso, Director of the Breast Unit of the Champalimaud Clinical Centre in Lisbon, Portugal, said: "Over-treatment is a problem in cancers with a low risk of recurrence. This important study shows that, at least at five years follow-up, radiotherapy focused around the tumour bed with the IMRT technique provides as good local control as whole breast radiation and is associated with fewer side effects. This may, indeed, lead to a change in practice with benefits for patients and society, since it will also reduce costs. Longer follow-up is needed, however, since low-risk breast cancer has a long natural history.”

* Coles C, et al. Partial breast radiotherapy for women with early breast cancer: First results of local recurrence data for IMPORT LOW (CRUK/06/003). Abstract number: 4LBA, presented at the 10th European Breast Cancer Conference.

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