Depicting a modern medical clinic, with advanced radiation therapy equipment in use for breast cancer treatment. A female patient undergoing therapy, expressing calmness, while medical staff monitor the process. The clinic has a sleek, high-tech atmosphere, with emphasis on care and patient comfort.
Radiation therapy plays a crucial role in breast cancer treatment, particularly after breast-conserving surgery. The use of different fractionation regimens, which vary the dose and frequency of radiation, has been extensively researched, and this article provides insights from a systematic review and meta-analysis.
Breast cancer remains the most common malignancy among women, making advancements in its treatment paramount. Historically, conventional radiation therapy has been the standard, consisting of approximately 50 Gray (Gy) doses administered over five to six weeks. While this method has proven effective in reducing cancer recurrence and improving survival rates, alternative approaches have emerged in recent years.
A Shift to Hypofractionation
Hypofractionated radiation therapy, which delivers higher doses over shorter time frames, has garnered attention due to its potential benefits. Studies conducted in the UK and Canada highlight its effectiveness, particularly in reducing treatment duration without compromising safety or efficacy.
“Moderate hypofractionation, with doses between 2.5 to 3.3 Gy, has shown comparable survival outcomes to conventional fractionation,” the researchers explain. This approach has also been associated with lower costs and improved convenience for patients.
However, more aggressive forms, such as ultrahypofractionation, which uses doses greater than 3.3 Gy, are still under investigation. “The relative novelty of ultrahypofractionation and the shorter follow-up data available has caused slower adoption in clinical practice,” the authors note.
Side Effects and Cosmesis: The Patient Perspective
One of the major concerns in radiation therapy, especially with newer fractionation schemes, is the potential for side effects. These can range from acute skin reactions to longer-term effects on the appearance of the treated breast, known as cosmesis.
“Patients are often worried about the impact of radiation therapy on their quality of life, not just in terms of recurrence rates, but also how their bodies will look and feel after treatment,” said Dr. Shing Fung Lee, one of the lead authors. Understanding these concerns is essential for clinicians when discussing treatment options with patients. The study found that moderate hypofractionation is associated with fewer side effects and better cosmetic outcomes compared to the more aggressive ultrahypofractionation regimens.
Financial and Practical Considerations in Cancer Care
The adoption of hypofractionated therapies also varies depending on the healthcare system. In countries where reimbursement is tied to the number of fractions administered, conventional fractionation remains more popular. “Financial incentives play a role in which treatments are adopted,” the authors explain. In contrast, in systems where reimbursement is capitated, hypofractionation is more frequently chosen due to its reduced number of treatment sessions.
However, the evidence supporting hypofractionation’s clinical efficacy continues to grow, and the study encourages healthcare systems worldwide to consider its broader adoption for suitable patients.
Looking Forward: Optimizing Patient Outcomes
As breast cancer treatment evolves, personalizing radiation therapy to suit each patient’s unique needs becomes ever more important. Factors such as tumor size, patient age, and personal preferences regarding side effects and cosmesis must be considered.
“This comprehensive review provides a clear comparison between fractionation schemes, highlighting the need for patient-centered care in determining the best treatment plan,” the authors conclude.
More information: Lee SF, Kennedy SK, Caini S, et al. Randomised controlled trials on radiation dose fractionation in breast cancer: systematic review and meta-analysis with emphasis on side effects and cosmesis. BMJ. 2023;386. doi:10.1136/bmj-2023-079089.
Journal information: The BMJ
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