A new study presented at the American Society for Radiation Oncology annual meeting in Washington, D.C., indicates that a shorter course of post-mastectomy radiation therapy does not negatively impact the success of breast reconstruction. The international Phase 3 trial, involving 898 patients, demonstrated that reducing treatment time from the standard five weeks to three weeks does not compromise reconstruction outcomes.
Impact of Shorter Radiation Course
Dr. Matthew Poppe, a professor of radiation oncology at the University of Utah and lead researcher, highlighted the significance of the findings. "Over the past 10 years, we've tried to move all patients who need breast radiation to a shorter, more convenient schedule," Poppe stated. The study addresses previous concerns about using shorter radiation courses in patients undergoing breast reconstruction after mastectomy.
The study revealed that a shorter course of radiation, consisting of 16 sessions compared to the traditional 25, could make post-mastectomy radiation more accessible for patients. Prior research has suggested that shorter treatment courses are equally effective in preventing cancer recurrence and can improve a patient's quality of life. However, these studies often excluded patients seeking breast reconstruction due to concerns about potential effects on the reconstructive process and increased side effects from higher daily radiation doses.
Study Details and Findings
The trial included patients with varying tumor sizes and lymph node involvement. The median age of participants was 46. Half of the patients received five weeks of conventional radiation, while the other half underwent a higher dose over three weeks. 51% received chemotherapy before their mastectomies, and 37% received it afterward. Among the 650 patients who underwent breast reconstruction, researchers monitored complications such as wound healing issues, reconstruction failure, and scar tissue formation over a median follow-up period of five years.
Two years post-reconstruction, 14% of patients in the shorter radiation group experienced complications, compared to 12% in the standard treatment group. Dr. Atif Khan, a radiation oncologist at Memorial Sloan Kettering Cancer Center and senior study author, noted that the complication rate was lower than anticipated. "We expected a complication rate of 25 to 35% based on prior, single institution studies of patients who received reconstruction surgery and radiation," Khan said.
Reconstruction Type and Recurrence Rates
The study also found that patients who underwent breast reconstruction using their own tissue experienced fewer complications (8.7%) compared to those who received implants (15.5%), regardless of the radiation treatment schedule. After three years, cancer recurrence rates were similar between the groups, with 1.5% in the shorter course group and 2.3% in the traditional treatment group. Dr. Khan pointed out that without radiation, recurrence rates after mastectomy can range from 20% to 30% for high-risk patients.
Implications for Clinical Practice
The researchers hope that these findings will encourage more cancer centers to offer shorter radiation courses for mastectomy patients. Dr. Poppe emphasized the benefits for patients, stating that the shorter treatment course saves both time and money. He noted, "There's been a slow start to moving to shorter treatment courses after mastectomy, even with no reconstruction, but now we have robust data...that clearly show the safety and effectiveness of short course radiation."
