Breast cancer: single dose radiotherapy ‘as effective as full course’

A single targeted dose of radiotherapy could be just as effective in treating breast cancer as a full course, a long-term study suggests.

Researchers said that people who received the shorter treatment were also less likely to die from other cancers and heart disease in the next five years.

But cancer specialists have raised concerns about the methodology of the study.

One-fifth of patients in the study received additional doses of radiotherapy.

The lead author of the study, Prof Jayant Vaidya, said he had expected a proportion of women to need additional radiotherapy because post-op tests could reveal tumors were larger than more aggressive than expected.

This allowed another 80% of women to benefit from a shorter course of treatment with fewer side effects, he said.

Targeted Intraoperative Radiotherapy (TARGIT-IORT) involves a single, targeted dose of radiation to the breast, immediately after the tumor has been removed.

This type of radiotherapy, developed by doctors at University College London (UCL), is delivered with a small device that is placed in the breast, directly on the side of the cancer.

It means that patients can receive radiation treatment at the same time as their surgery to remove their cancer.

And they would not have to return for further treatments, which could involve 15 to 30 hospital visits for people who have a standard course of radiotherapy.

This treatment is already available on the NHS in a small number of clinics that have the right equipment.

During the pandemic, NHS England reduced the number of visits people need for standard radiotherapy after surgery to about five.

The TARGIT-A trial involved 2,298 women with breast cancer in 10 countries who received targeted therapy during surgery as a standard course of radiotherapy between 2000 and 2012.

The study reported on the 10-year mark that a single dose of radiation during surgery was as effective as a longer course.

This latest study, which followed women five years after their treatment, confirmed that conclusion, the researchers said.

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And it found that fewer in the group who received the treatment with one dose died of other causes, including heart disease, lung problems and other cancers.

UCL said previous studies showed that the treatment also had less radiation-related side effects, including pain and changes to the chest.

‘Cancer-free’

Writer Marcelle Bernstein received the one-time treatment eight years ago, and has been very clear ever since.

“Within two months of being diagnosed, I was cancer free,” she said.

And, after seeing her mother die of breast cancer 25 years earlier, she felt it was important that she “would not be a cancer sufferer any longer than necessary”.

“I just liked the idea of ​​what to treat just the small affected area and not touch the rest of the body,” she said.

However, 20% of the women in the study gave a single dose of radiation, continued with further radiotherapy treatments, when tests revealed “unexpected factors with higher risk”.

Worries

Joanne Haviland at the Institute of Cancer Research was concerned about some of the definitions the researchers used in their study.

“Conventional radiotherapy has been highly developed since the design of the TARGIT-A trial, including shorter treatment schedules and smaller volumes of treated breast, with greatly improved patient experience and extremely high levels of clinical healing at very low cost to the NHS.”

Martin Ledwick of Cancer Research UK said: “When the women participating in the study received radiotherapy at the same time as a lumpectomy, doctors could not analyze their tumors in advance to see if they would need a longer course of radiotherapy until after their operation.

“While 20% of the women in this study then needed additional treatment, 80% of the patients were spared this.”