ASTRO: Short-course radiation is effective after mastectomy

A short-course radiation protocol is effective for women who have undergone implant-based breast reconstruction after mastectomy, according to research presented October 1 at the American Society for Radiation Oncology (ASTRO) annual meeting.

Not only was the shorter protocol as effective as a standard one but it also did not increase side effects and saved both time and money, reported senior study author Rinaa Punglia, MD, of Dana-Farber Brigham Cancer Center in Boston.

"Both the accelerated and standard courses of treatment were equally effective at preventing the cancer from returning and had the same level of side effects," Punglia said in an ASTRO statement. "But with shortening the treatment from five weeks to three, patients experienced fewer treatment disruptions, a lower financial burden and other meaningful improvements to their lives."

Roughly 40% of women with breast cancer have mastectomies and of these, 62% undergo reconstruction surgery, Punglia noted. But about a third of patients who undergo mastectomies need radiation therapy as well. Standard treatment is administered over five weeks

Punglia and colleagues conducted a study called "Radiation Fractionation on Patient Outcomes After Breast REConstruction for Invasive Breast Carcinoma" (FABREC) to compare quality-of-life and clinical outcomes after shortened versus conventional radiation therapy for women with post-mastectomy implant- or tissue-based breast reconstruction. The work included 400 women who underwent mastectomies followed by breast reconstruction; of these, 201 received conventional radiation (25 fractions over five weeks for a total of 50 Gy) and 199 a shortened protocol (16 fractions over three weeks for a total of 43 Gy). The women completed questionnaires about their physical well-being and quality of life at baseline and at six, 12, and 18 months post-treatment.

Women in both study arms reported similar levels of physical well being (p = 0.71), although there were some differences at baseline, with the short protocol cohort reporting higher energy levels (p = 0.02). The investigators also found that breaks in treatment were fewer among the shortened protocol group compared with the standard protocol group (2.7% vs. 7.7%) and if breaks occurred, they were shorter (average, 2.8 days vs. 3.3 days). Women who underwent short radiation treatment reported having to take far fewer hours of unpaid leave compared with their standard treatment counterparts (73.7 hours vs. 125.8 hours).

Finally, Punglia and colleagues reported that there were no differences in rates of breast cancer recurrence or side effects between the two groups.

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