Five-year quality-of-life follow-up results from the
START trials showed that women with early-stage breast cancer who received
hypofractionated radiation reported fewer adverse effects than women assigned
to the standard regimen of 50 Gy in 25 fractions.
The START trials were two concurrent trials. START A
compared standard radiation of 50 Gy given in 25 fractions for five weeks with
hypofractionated radiation of 39 Gy or 41.6 Gy given in 13 fractions for five
weeks. START B was a non-inferiority trail comparing the standard radiation
schedule with 40 Gy given in 15 fractions over three weeks. Researchers
evaluated 2,208 patients who had undergone radiation after primary surgery for
quality of life.
They found that the rate of moderate or marked change in
skin appearance after radiotherapy was lower in the 39 Gy arm (HR=0.63; 95% CI,
0.47-0.84) and the 40 Gy arm (HR=0.76; 95% CI, 0.60-0.97) compared with the 50
Gy arm. No difference was found for the 41.6 Gy arm in START A and the standard
radiation schedule.
Although researchers did not observe any other
significant differences between radiation schedules, they said there was a
similar pattern for other post-radiotherapy effects. Patients in the 39 Gy arm
had the lowest rates of adverse effects in trial A, as did patients in the 40
Gy arm of trial B.
When comparing the 41.6 Gy and 39 Gy arms of trial A,
researchers noted that the 39 Gy arm had lower rates of breast hardness after
radiotherapy, oversensitivity in area of affected breast, change in breast
appearance after radiotherapy and change in skin appearance after radiotherapy.
Feeling physically less attractive and dissatisfaction
with body (both 23%) were the most common moderate or marked concerns reported
by patients. Researchers said body image scale summary scores were similar in
all fractionation schedules over time.
Writing in an accompanying editorial, Julie B.
Schnur, PhD, assistant professor in the department of oncological sciences
with Mount Sinai School of Medicine, New York, praised Hopwood and colleagues
for exploring the oft-overlooked perspective of the patient.
“The study’s findings provide a strong
foundation for further pursuit of understanding of the patient’s
experience of adverse skin changes after radiotherapy,” Schnur wrote.
“Indeed, at least five areas of future research are readily apparent.
… Hopefully, the work by this group will inspire both researchers and
clinicians to make understanding and assessment of patients’ experiences a
top priority.”
Hopwood P. Lancet Oncol.
2010;doi:10.1013/S1470-2045(09)70382-1.