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A shorter course of radiation therapy after mastectomy and breast reconstruction surgery provides the same protection against breast cancer recurrence and equivalent physical side-effects as longer course, suggests a study.

However, the study showed that patients reported less burden on life and finances with shorter treatment regimen.

Hypofractionated radiation therapy provides a higher dose of radiation in each session and is completed in three weeks while conventional radiation therapy delivers a lower dose over five weeks. 

“Our trial results suggest that hypofractionation can safely be used in this setting without compromising efficacy or increasing side effects,” said Rinaa S. Punglia, a radiation oncologist at Dana-Farber Brigham Cancer Center in the US.

“Reducing the requirement to three weeks of radiation therapy would be a significant improvement in the quality of our patients’ lives.”

Many patients with breast cancer opt for a mastectomy to reduce the chances of cancer recurrence. For one in three of these patients, postmastectomy radiation therapy is recommended to further reduce the chance of recurrence.

More and more women opt for implant-based reconstruction to be done as part of the mastectomy. 

However, radiation therapy increases the risk of complications with breast reconstruction, including an increased risk of infection, and cosmetic risks such as the formation of scar tissue around the breast that causes hardness and asymmetry.

“We know that radiation can cause unwanted changes to cosmetic results in patients who have mastectomy and reconstruction,” said Julia S. Wong, a radiation oncologist at Dana-Farber.

“With this trial we were looking for a way to improve quality of life and cosmetic results without sacrificing efficacy.”

The results were presented at the American Society for Radiation Oncology (ASTRO) annual meeting in San Diego, CA.

For the study, the team recruited 400 patients with stage 0 to III breast cancer who were treated with mastectomy and immediate implant-based radiation and who required post-surgical radiation therapy.

 Oncologic outcomes were very similar between the two groups, with comparable numbers of patients experiencing recurrence after a median of 40 months of follow-up. Radiation related side-effects were also similar.

The patient-reported improvement in physical well-being assessment, and that the shorter course of treatment did not lead to a larger improvement in quality of life. 

Among patients younger than 45, there was a small but statistically significant benefit in physical well-being for those who received the short course radiation therapy at the 6-month timepoint.

“The difference between three weeks and five weeks presents a significant improvement in the quality of our patients’ lives in terms of the disruption of their work, family, social, and financial lives,” Wong said.

Further, fewer patients receiving the shorter course of radiation therapy missed a day of therapy. Interruptions in radiation can lead to worse outcomes.