Advancing Radiation Therapy: Shorter Courses for Breast Cancer Patients
Spectrum Healthcare Partners has always valued research that advances treatment options and improves the quality of life for patients. Recently, one of Spectrum’s radiation oncology physicians co-authored a study that could significantly improve the quality of life for many breast cancer patients receiving radiation therapy.
Radiation treatment for breast cancer is delivered over the course of several weeks. This includes radiation given “postmastectomy,” that is, after the removal of one or both breasts.
Typically the radiation gets divided into doses that are delivered each weekday over a set number of weeks. Each radiation treatment is called a “dose fraction.” The full course of treatment is known as “conventionally fractionated” radiation therapy.
However, that’s not the only way to structure the treatments. It’s also possible to deliver fewer, larger doses (or “dose fractions”) of radiation to a patient after a mastectomy over a shorter period of time. This is called hypofractionated radiation therapy.
With both conventional and hypofractionated radiation, typically the patient receives radiation therapy five days in a row each week. In the conventional fractionation regimen, the schedule lasts for five weeks. Hypofractionation therapy, however, gets completed in two or three weeks.
In collaboration with Dana-Farber Cancer Institute and other leading experts, Matthew Cheney, MD, PhD, managing director of Spectrum’s radiation oncology division, co-authored the study “Hypofractionated vs. Conventionally Fractionated Postmastectomy Radiation After Implant-Based Reconstruction: A Randomized Clinical Trial,” published in JAMA Oncology in August 2024.
“This was the brainchild of Dana-Farber, and many experts contributed to this multi-institutional study,” says Dr. Cheney. “We aimed to determine whether we could safely shorten radiation therapy courses for patients after implant-based reconstruction.”
Inside the Study
Conducted across 16 hospitals in the U.S., this study included 400 women with breast cancer who underwent implant-based reconstruction followed by postmastectomy radiation therapy. The participants ranged in age from 23 to 79, with a median age of 47.
The patients were divided into two treatment groups at random. The first group of 201 women received conventional fractionation therapy, which delivered a total radiation dose of 5000 cGy across 25 treatments. “Gy” stands for “gray,” the unit of measurement for an absorbed dose of radiation. This can also be recorded as centigray (cGy), which is 0.01 of a single Gy unit.
The second group of 199 women underwent hypofractionation therapy. This shorter regimen provided a total dose of 4256 cGy over 16 treatments.
“Our goal was to see if this condensed radiation schedule could save patients time and money while improving their wellbeing,” says Dr. Cheney. “We also wanted to explore how we could better allocate healthcare resources to benefit patients, providers, and society.”
Optimizing Resources for Better Care
“We’ve worked hard to compress radiation courses in the last two decades,” says Dr. Cheney. “For years, the belief was that spreading treatment over many weeks was the only safe option. However, with technological advances in radiation delivery, we now know that’s not necessarily true.”
The study results support the safety of this compressed hypofractionated course. Cancer recurrence rates and side effects were comparable between the two groups. This study also showed no significant difference in the change in Physical Well-Being (PWB) scores at six months between the two treatment groups.
Although the numbers may not significantly differ, the impact on patients’ lives can be substantial. Hypofractionation therapy allows patients to complete radiation in fewer sessions, helping them put treatment in the rearview mirror sooner.
“I think we often forget the burden patients face—traveling to and from the treatment center, lost work time, arranging childcare, and the emotional toll of repeatedly entering the radiation oncology department,” says Dr. Cheney. “For many, treatment can stretch over a year, so cutting two weeks off might seem small, but it makes a significant impact on them.”
A shorter treatment course can also alleviate some of the challenges in radiation oncology.
“There are only so many of us, only so many machines, and only so many hours in the day,” explains Dr. Cheney. “With an increasing number of patients, hypofractionation allows us to treat more people with the same resources while reducing the number of sessions—and ultimately lowering the cost for patients.”
The Future of Radiation Therapy
This study, along with similar research, is helping both providers and patients become more confident that shorter radiation courses will become the new standard of care.
“New studies and trials are exploring whether we can compress treatment even further,” says Dr. Cheney. “This gives me some pause, as we don’t yet have the same evidence to prove that one-week radiation courses are equivalent to the three-week options.”
Dr. Cheney points out that we have had at least a decade of follow-up data on moderate hypofractionated treatments before moving into studies like this.
“I’m concerned about the possibility of unforeseen long-term side effects for younger patients with long lives ahead,” he adds. “Still, we’ll continue to follow the research as the field looks into more compressed treatment schedules.”
The Real Champions of the Study
Four hundred women participated in this study, which is significant.
“I can’t emphasize enough how grateful I am to these women, many of them from Maine, for their willingness to participate,” he says.
“I can only imagine the challenges they faced undergoing treatment and surgery so closely tied to their identity and emotions, and then accepting additional risks by joining this study.”
Dr. Cheney acknowledges that many of these women, some very young, gave an invaluable gift to future breast cancer patients. Their participation contributes to the finding that hypofractionated treatments are safe and can reduce the length of therapy for patients.
“These women are the reason we do this work,” says Dr. Cheney. “Breast cancer is a challenging diagnosis. We’re committed to doing everything we can to ease the burden of treatment and help them focus on recovery and getting their lives back.”
