More targeted and less aggressive radiotherapy for low-risk breast cancer could spare thousands of women from the harsh side-effects of the treatment, a Cambridge-led trial has found. The approach has 'transformed' early stage care and is now being adopted across the NHS.
More than 37,000 women have radiotherapy for breast cancer in the UK every year. The treatment uses radiation to kill cancer cells and is usually given after surgery to reduce the risk of the disease coming back. Side-effects can include changes in breast size and shape, swelling in the arms or breast, and pain.
Charlotte Coles, honorary consultant at Addenbrooke's Hospital and Professor of Breast Clinical Oncology at the University of Cambridge, co-led the trial with Professor Judith Bliss from the Institute of Cancer Research, London.
The trial, known as IMPORT LOW, found that limiting radiation to the tumour area was just as effective at treating cancer as radiotherapy targeting the whole breast.
Professor Coles previously led the IMPORT HIGH trial exploring improved radiotherapy for higher-risk breast cancer patients.
Patients receiving partial-breast radiotherapy experience fewer side-effects while maintaining excellent cancer control.
Charlotte Coles, honorary consultant at Addenbrooke's Hospital and Professor of Breast Clinical Oncology at the University of Cambridge
The study, which is published today in The Lancet Oncology, included 2,018 women across 30 radiotherapy centres in the UK, who were monitored for 10 years after treatment. It compared three radiotherapy approaches; whole-breast, partial-breast and a reduced-dose.
Partial-breast radiotherapy is now part of standard NHS treatment guidelines and is expected to benefit more than 9,000 women in the UK each year. The approach is endorsed by the Royal College of Radiologists and Association of Breast Surgery.
Targeted cancer treatments and precision breast cancer medicine underpins the focus of care that will be offered through the Cambridge Cancer Research Hospital.
The state-of-the-art facility will house three world-leading research institutes focused on detecting cancer earlier, integrated cancer medicine and personalised breast cancer treatment.
By targeting the area around the tumour, rather than the whole breast, we have demonstrated that patients can achieve the same outstanding long-term outcomes with fewer complications.
Professor Charlotte Coles
After a decade, cancer recurrence rates in the group given partial radiotherapy was 3%, the same proportion as those who had been treated with a more aggressive approach.
Patients who had targeted radiotherapy were also less likely to experience long-term changes in breast appearance. 15% reported noticeable changes at five years compared with 27% in the whole-breast radiotherapy group.
The study was funded by Cancer Research UK and supported by the National Institute for Health and Care Research's Biomedical Research Centres in Cambridge and at the Royal Marsden and The Institute of Cancer Research.
This latest analysis confirms that partial breast radiotherapy remains a safe and effective treatment option, supporting its continued adoption as the standard of care in the UK and globally.
Dr Fay Cafferty, lead statistician at The Institute of Cancer Research, London
Hilary's Story
Hilary Stobart, now 70, was diagnosed with ER-Positive breast cancer in December 2008 which revealed a two-centimetre tumour in her left breast.
Hilary, then aged 54, underwent wide local excision surgery at Addenbrooke's and was then offered the chance to take part in the IMPORT-LOW trial. She was treated with partial breast radiotherapy as part of the trial. She says:
“I had three weeks of radiotherapy, but suffered no side effects, other than some soreness in my breast and nipple in the first few weeks.
Ten years on, I am doing fine. I have no side effects and no recurrence of disease. For me personally, I am very thankful to have received the lowest dose of radiotherapy.
Hilary
“Whilst I may have had some niggling worries in the early days, having seen the results of the trial, I feel positive and optimistic now. I know that I was lucky enough back then to have had the best treatment, a treatment that other women will be routinely offered now."
I am excited to have been part of a trial that has made a noticeable difference to the way in which breast cancer patients are treated now and in the future.
Hilary