A LOWER total dose of radiotherapy, delivered in fewer, larger treatments has been shown to be as effective as the international standard of a higher total dose delivered over a longer time to treat women with early breast cancer – according to new research published in the Lancet and Lancet Oncology today. This confirms long-held beliefs of cancer specialists in the UK who have been using shorter schedules for many years.

Nearly 4,500 women took part in the START* Trials co-ordinated by the Clinical Trials and Statistics Unit at The Institute of Cancer Research and funded by Cancer Research UK, the Medical Research Council and the Department of Health. Just under half the women received the international standard radiotherapy delivering 25 treatments, treating five times per week over five weeks. The remainder received a lower total dose given in fewer, larger treatments in either three or five weeks.

Researchers then compared the rate of cancer recurrence in the treated breast along with the effects of the treatment on surrounding healthy breast tissues.

After an average follow-up of five to six years, the rate of recurrence in the breast remained very low for patients in each of the treatment groups studied. The rate of side-effects were low overall, and no higher in women receiving the revised treatment than those receiving the international standard of 25 treatments. The results suggested that a lower total dose given in fewer larger treatments is as safe and effective in treating early stage breast cancer as the longer standard schedule.

Shorter radiotherapy treatments have been used in the UK for many years with promising results but this is the first systematic and reliable evaluation to compare the longer international treatment and the shorter revised UK treatment.

The benefits of fewer sessions of radiotherapy to patients with early breast cancer mean fewer trips to the hospital for treatment, which in turn mean less upheaval in a daily routine. Reducing the number of trips to the hospital is also financially beneficial to patients. The results also offer new insights into how breast cancer cells handle radiotherapy damage to the DNA, suggesting how treatments might be improved further.

Chief Investigator, Professor John Yarnold, from The Institute of Cancer Research and the Royal Marsden Hospital, said: “These trials represent a successful 10-year collaboration between cancer specialists and several thousand women motivated to help others by volunteering for research. The results suggest that a high total dose given in 25 small treatments is no better than simpler schedules using fewer exposures to a lower total dose. Shorter therapies giving fewer, larger treatments are obviously convenient for patients. The results support the current use of shorter schedules in the UK and in other countries.”

Professor Mike Richards, National Cancer Director, said: “We welcome these findings which show that women receiving radiotherapy for breast cancer can be effectively treated with fewer hospital visits. These results are good for patients and good for the NHS.”

Sir Leszek Borysiewicz, Chief Executive of the Medical Research council said: “This research will help to refine the way we treat women who are battling this disease. The research will lead to fewer sessions of radiotherapy. This work will help patients with early breast cancer. They’ll have to go to hospital for treatment less often which means fewer trips to cancer units. But the results will also help us to understand this disease better at a genetic level so we can make treatments even better in the future.”

Dr Lesley Walker, Cancer Research UK’s director of cancer information, said: “Cancer treatment disrupts the lives of patients and their families for many weeks at a time so this is a really positive result. Fewer doses of radiotherapy that don’t increase side-effects while providing the same benefits means less time at hospital and more time at home. It is important for patients that we continue research like this to fine tune current treatment.”


For media enquiries please contact Paul Thorne in the Cancer Research UK press office on 020 7061 8352 or, out of hours, the duty press officer on 07050 264059.


*START Trial – Standardisation of Breast RadioTherapy

START Trial B study published in the Lancet; START Trial A study published in Lancet Oncology

The international standard radiation therapy for women with early breast cancer is typically given to a dose of 50 Gy (Gy = the unit of radiation dose) delivered in 25 fractions five days a week over a period of five weeks (2.0 Gy per fraction).

4,451 women who had had surgery to remove breast cancer from across the UK took part in the START trials. These comprised of two parallel studies.

Trial A recruited 2,236 women who then received either the international standard radiotherapy or a lower overall dose of 41.6 Gy or 39 Gy delivered every other day for five weeks

Trial B recruited 2,215 women who received either the international standard radiotherapy or 40 Gy given in 15 doses over three weeks.

The START Trials are currently the largest studies to explore the safety and efficacy of this approach, called hypofractionation, in women with early breast cancer.

Radiotherapy side-effects can include moderate or marked oedema (swelling), breast shrinkage, telangiectasia (visible small blood vessels) and induration (hardening of the tissue).

35 different hospitals from across the UK took part in the study.

Breast cancer is now the most common cancer in the UK. Each year more than 44,000 women are diagnosed with breast cancer, that’s more than 100 women a day.

The START Trials are funded by Cancer Research UK, the Medical Research Council and the Department of Health. The Chief Investigator is Professor John Yarnold of The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust. The Clinical Trials and Statistics Unit of The Institute of Cancer Research (ICR-CTSU) co-ordinated the trial under the direction of  Professor Judith Bliss.

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The Institute of Cancer Research is Europe’s leading cancer research centre with expert scientists working on cutting edge research. It was founded in 1909 to carry out research into the causes of cancer and to develop new strategies for its prevention, diagnosis, treatment and care.

The Institute of Cancer Research’s Clinical Trials and Statistics Unit (ICR-CTSU) is an academic clinical trials unit accredited by the National Cancer Research Institute (NCRI) to conduct clinical trials into cancer treatments. The department is funded by an infrastructure grant from Cancer Research UK.

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