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Less is more for radiotherapy in early breast cancers

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by Cancer Research UK | News

19 September 2013

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Giving radiotherapy in fewer, larger treatments is at least as safe and effective at treating early breast cancer as the international standard dose, according to the 10-year follow-up results of a major Cancer Research UK trial, published in The Lancet Oncology.

Nearly 4,500 women across the UK have taken part in the START trials, which were co-ordinated by the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, and funded by Cancer Research UK, the Medical Research Council and the Department of Health.

The five-year results showed it was just as effective and safe to give women a lower total dose of radiotherapy in fewer, larger treatments than the 25-dose international standard, following primary surgery for early breast cancer. As a result, the shorter treatment course of 15 treatments was adopted in the UK in 2008, but the longer course is still used in many other countries.

This ‘less is more’ treatment routine has other important benefits for patients, such as the need for fewer trips to hospital. It will also result in cost savings for the health service.

The 10-year follow-up, funded by Cancer Research UK, confirms these benefits and shows that the relapse rates of cancer within the same breast are similar to the international standard course of radiotherapy following surgery.

Chief investigator Professor John Yarnold, professor of clinical oncology at The Institute of Cancer Research (ICR) and honorary consultant at The Royal Marsden NHS Foundation Trust, said: “We’ve shown conclusively that less can be more in breast cancer radiotherapy. Three weeks of radiotherapy is as good as five weeks – as well as being more convenient and less tiring for patients. It also has the added benefit of being cheaper for the health service.

“Both breast cancer recurrence and the side-effects of radiotherapy can occur many years after treatment, so these long-term results provide an important reassurance that the shorter treatment course is the best option for patients. Some doctors may have been hesitant to change their practice on the basis of five-year results, but these long-term findings should convert those sceptics.”

The same team is now setting out to investigate whether even fewer doses of radiotherapy could be just as effective, as part of a new Phase III randomised controlled trial of 4,000 women called FAST-FORWARD. The trial will compare the new standard 15-dose course of radiotherapy treatment, delivered over three weeks, with an even shorter five-dose course, delivered over one week.

Kate Law, Cancer Research UK’s director of clinical trials, said: “What’s really exciting is that, as a result of this trial, women are already benefiting from the added physical and emotional wellbeing of needing fewer hospital visits for their treatment. Minimising the long-term side effects of treatment is becoming increasingly important as more cancer patients live longer. We hope that women around the world will now be able to benefit from this improved standard of care.”


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Haviland J. S., et al The UK Standardisation of Breast Radiotherapy (START) randomised trials of radiotherapy hypofractionation for treatment of early breast cancer; 10-year follow-up results. Lancet Oncology, 2013, DOI: PIIS1470-2045(13)70386-3