Radiation Dose Change: Better Results?

(Ivanhoe Newswire) -- Breast cancer patients who received a lower overall dose of radiation therapy in fewer, higher doses (hypofractionated) didn't report an increase in adverse symptoms or worsened body image in a new study. These results add to the evidence that shorter hypofractionated radiotherapy schedules do not cause more side effects in the breast, are equally effective at reducing the risk of further cancer in the breast and thus provide better quality of life for patients.

Penelope Hopwood and colleagues from The Institute of Cancer Research, UK and the Royal Marsden NHS Foundation Trust, UK examined the patients' experience of adverse breast, arm, and shoulder symptoms and functional outcomes and body image after different radiotherapy regimens for up to five years after treatment.

A total of 2,208 women given radiotherapy after primary surgery for early-stage breast cancer, recruited from START (Standardization of Breast Radiotherapy Trials), completed quality-of-life questionnaires and self-assessments of body image and radiotherapy effects on healthy tissues at regular intervals for five years after treatment.

The most frequently reported adverse effects were breast hardness and change in breast appearance. In addition, up to a third of patients experienced arm and shoulder pain, while the five-year rate of moderate or marked shoulder stiffness was about 20 percent.

Adverse change in skin appearance after radiotherapy was the only symptom to differ significantly between the radiotherapy schedules, but the overall pattern for all adverse effects was similar, with lower or similar rates for the schedules with a higher daily dose compared with the international standard treatment.

The team found that 40 percent of women reported moderate or striking concerns up to five years following treatment, such as feeling physically less attractive and being dissatisfied with their bodies.

The authors were quoted as saying, "Considerable morbidity still arises due to effects on normal [healthy] tissues of treatment for early breast cancer, and patients' self-assessments are important to ascertain the extent and duration of these effects."

They added, "These ratings by patients … strengthen evidence in favor of hypofractionated regimens, [with the potential for] reduced adverse normal breast tissue effects reported … [and] have important implications for radiotherapy practice."

SOURCE: Online, Lancet Oncology, February 7, 2010

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