The phase III FAST-Forward trial has demonstrated that a 1-week course of post-surgical radiotherapy provides comparable long-term safety and efficacy to the traditional 3-week regimen for patients with early-stage breast cancer, according to 10-year follow-up data presented at the European Society for Radiotherapy and Oncology (ESTRO) 2025 Annual Meeting.
The landmark study, which followed approximately 4,000 patients, found that the abbreviated treatment protocol maintained equivalent cancer control while causing no additional adverse effects compared to the standard approach, potentially transforming treatment paradigms worldwide.
10-Year Data Confirms Efficacy of Shorter Treatment Course
The FAST-Forward trial randomly assigned patients with early-stage breast cancer to receive either the standard 3-week radiotherapy course (40 Gy administered in 15 treatments) or a shorter 1-week course (27 Gy or 26 Gy administered in 5 treatments).
After a decade of follow-up, researchers confirmed that the 1-week radiotherapy regimen provided similar cancer control outcomes compared to the 3-week course. Importantly, the abbreviated schedule did not result in any increase in long-term adverse effects, addressing a critical concern in radiation oncology where late toxicities can emerge years after treatment.
"This 10-year analysis provides definitive long-term evidence that 1-week radiotherapy to the breast is a safe, effective, and more practical option for patients with breast cancer," said lead study author Murray Brunt, MBBS, FRCR, FRCP, Professor at the University of Keele.
The findings build upon previous 5-year results that had already begun shifting clinical practice patterns in many centers globally.
Patient-Centered Benefits and Healthcare System Advantages
The abbreviated treatment schedule offers multiple advantages beyond equivalent oncologic outcomes. Patients benefit from greater convenience, fewer hospital visits, and reduced disruption to daily life during the treatment period.
Senior study author Judith Bliss, MSC, Professor of Clinical Trials at The Institute of Cancer Research in London, emphasized the broader implications: "The FAST-Forward trial revolutionized cancer treatment by reducing the standard radiotherapy from 3 weeks to just 1 week, without compromising effectiveness. This approach has significantly improved patient experience and healthcare practices, both during and after the COVID-19 pandemic, by minimizing hospital visits."
The pandemic highlighted the value of treatment protocols that limit healthcare facility exposure while maintaining efficacy, a benefit that extends beyond the immediate crisis.
Global Access and Resource Optimization
The streamlined radiotherapy schedule has particular significance for healthcare systems with limited resources and for patients facing geographic or socioeconomic barriers to treatment.
"The streamlined schedule has made radiotherapy more accessible to more women, particularly those who are less able to attend hospital and those from lower-income countries," Professor Bliss noted.
This aspect of the findings addresses a critical global disparity in cancer care access, where complex, prolonged treatment regimens can be prohibitive for many patients worldwide.
Matthias Guckenberger, MD, President of ESTRO and Chair of Radiation Oncology at the University Hospital Zurich, contextualized the findings within the broader landscape of cancer treatment: "Radiotherapy is a cornerstone of modern cancer treatment, and studies like FAST-Forward demonstrate how we can optimize its delivery to benefit more patients. By reducing treatment time without compromising effectiveness, we are not only improving patient experience but also making better use of radiotherapy resources and healthcare systems worldwide."
Clinical Implementation and Future Directions
The FAST-Forward results represent a significant milestone in the ongoing effort to optimize breast cancer radiotherapy. The 10-year data provides the long-term evidence needed for widespread adoption of the 1-week protocol in appropriate patient populations.
For radiation oncology departments, the shorter schedule potentially allows for more efficient use of treatment machines and staff resources, potentially increasing overall treatment capacity without requiring additional infrastructure investment.
The success of the FAST-Forward approach may also inspire similar investigations in other cancer types where prolonged radiotherapy courses remain standard, potentially extending the benefits of abbreviated treatment to broader patient populations.
As healthcare systems worldwide continue to face resource constraints and increasing demand, evidence-based approaches that maintain efficacy while improving efficiency and patient experience will likely play an increasingly important role in cancer treatment paradigms.
