Against breast cancer, these shorter but more effective radiotherapies are a small revolution

HEALTH – Radiotherapy treatments shortened to three weeks instead of five for all breast cancer patients: this is the hope fueled by a new study led by a French oncologist-radiotherapist, Dr. Sofia Rivera. Presented this Sunday, September 15 at Esmo, the annual congress of the European Society of Medical Oncology, which is being held in Barcelona (Spain) until Tuesday, this new research could lead to a change in the treatment of breast cancer.

Fewer sessions but higher doses

The phase 3 study led by Dr. Rivera evaluated 1,265 patients over five years and compared the effects of standard five-week radiation therapy with a new regimen, called “ hypofractionated »that is, shortened to three weeks.

All of these women had node-positive breast cancer, meaning the tumor was no longer localized but had spread to the lymph nodes. Some of the patients in the study received slightly higher doses at each session, but had fewer appointments overall. “From previous studies, we knew that the effectiveness of shorter radiotherapy was the same in the case of a localized tumor, but for women with lymph node involvement, there was nothing to date demonstrating that we could shorten the number of sessions”explained to AFP Sofia Rivera, also head of department at the French Gustave-Roussy Institute.

To reduce the sessions to three weeks, the radiation dose was increased slightly each time. “When we treat the breast but also the lymph nodes, we are attacking much larger volumes, which include healthy tissues such as the lung, the heart, or the esophagus”says Sofia Rivera. So with a higher dose, we could fear more side effects related to the treatment.

The results of the study dispelled this fear: furthermore, “ we have an overall survival rate, survival without recurrence and without metastasis which is even better” with this therapy “ hypofractionated »the oncologist rejoices.

In view of these data, it is very likely that shortened radiotherapy will soon also be offered to women with lymph node-positive breast cancer, which represents 30% of breast cancers. “This will mean less heavy treatments; we are clearly moving towards a de-escalation of the therapeutic burden”enthuses Sofia Rivera.

A better quality of life

Reducing the number of sessions will in fact limit the number of trips patients have to make to their treatment centre. It’s a gain in quality of life”rejoices the oncologist. Also key: a reduction in waiting lists, since places will be freed up on radiotherapy machines, and a gain in human resources.

Charlotte Coles, an oncologist and professor at the University of Cambridge, welcomed a study on Sunday that “ really important »which should lead to relief “ the burden on the sick” And “ reduce the costs of health care systems ».

This study is part of a body of research that is generally moving in the same direction. A meta-analysis published last week in the British medical journal (BMJ), which pooled trials involving more than 20,000 patients, concluded that administering higher doses per fraction of radiotherapy over a shorter period significantly reduced the risk of side effects and improved quality of life.

A study that shakes up the profitability of establishments

For breast cancer alone, studies first showed that three weeks of radiotherapy (15 sessions) gave as good results as five weeks (25 sessions). Then other studies showed that five sessions were as good as 25 or 15. The next step will be to test five sessions over a week for breast cancers with lymph nodes. Studies are underway but it will be at least five years before the first results.

In France, however, one obstacle could delay the implementation of this new standard: radiotherapy is still currently paid per act and not as a flat rate. It is therefore more profitable for establishments to offer a large number of sessions.

Also see on The HuffPost :