breast radiation short v longer time

Long-term data support hypofractionated radiotherapy after primary surgery for early breast cancer. Despite the convenience and potential cost-savings of shorter courses of adjuvant breast cancer radiation, concerns about this approach have focused on long-term local control and cosmesis. Prior trials have allayed these fears to some degree, but most U.S. clinicians have been cautious about adopting shorter radiation courses, citing inadequate long-term follow-up as the primary concern. Now, U.K. investigators report long-term results of the randomized, controlled, Standardisation of Breast Radiotherapy trials (START-A and START-B), which evaluated various doses and schedules of postoperative breast radiation in women with completely excised invasive breast cancer. In START-A, 2236 patients were randomized to 50 Gy in 25 fractions over 5 weeks versus either 41.6 Gy or 39 Gy in 13 fractions over 5 weeks. At a median follow-up of 9.3 years, 10-year rates of local-regional relapse did not differ significantly between the 41.6 Gy and 50 Gy groups or between the 39-Gy and 50-Gy groups. Moderate or marked breast induration, telangiectasia, and breast edema were significantly less common normal-tissue effects in the 39-Gy group than in the 50-Gy group. Normal tissue effects were similar in the 41.6-Gy and 50-Gy groups. In START-B, 2215 patients were randomized to 50 Gy in 25 fractions over 5 weeks versus 40 Gy in 15 fractions over 3 weeks. At median follow-up of 9.9 years, 10-year rates of local-regional relapse were similar in both groups. Breast shrinkage, telangiectasia, and breast edema were significantly less common normal-tissue effects in the 40-Gy group than in the 50-Gy group. Haviland JS et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 2013 Oct; 14:1086. - See more at: http://www.jwatch.org/na32352/2013/09/27/breast-radiation-shorter-good-longer?query=etoc_jwonchem#sthash.JE8RgOCP.dpuf