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Fewer, bigger doses of radiotherapy benefit breast cancer patients


Thursday 6 December 2012


Women diagnosed with breast cancer can benefit from receiving fewer but higher doses of radiotherapy than is the international standard, according to long-term follow-up data of a major UK-wide trial led by The Institute of Cancer Research, London.

Jo Haviland, a senior statistician at The Institute of Cancer Research (ICR), will present the new START trial results at the CTRC-AACR San Antonio Breast Cancer Symposium today.

From 1999, nearly 4,500 women in the UK took part in the START trials, which were co-ordinated by the ICR’s Clinical Trials and Statistics Unit and funded by Cancer Research UK, the Medical Research Council and the Department of Health. The trials showed that it was just as effective and safe to give women a lower total dose of radiotherapy in fewer, larger treatments than the 25-dose international standard. The new treatment regimens also offered important benefits for women, including fewer trips to hospital, as well as cost savings for the health service.

However, the previously published results were only for the five years after treatment and until now it has been unclear whether a shorter radiotherapy course would continue to be as effective and safe in terms of side-effects in the long-term. The new 10-year follow-up results, funded by Cancer Research UK, show the benefits do continue and that very few women experience a relapse of their cancer within the breast when they are given a short course of radiotherapy after surgery (6.2 per cent at 10 years).

Trial chief investigator Professor John Yarnold, professor of clinical oncology at The Institute of Cancer Research (ICR) and honorary consultant at The Royal Marsden NHS Foundation Trust, said: “The risk of breast cancer recurring continues beyond five years, and side-effects of radiotherapy can often develop many years after treatment, so these long-term results provide a very important reassurance that the shorter treatment course is definitely the best option for patients. Some doctors may have been hesitant to change their practice on the basis of five-year results, but these long-term findings should convert those sceptics.

“We have shown conclusively that less can be more in breast cancer radiotherapy. Three weeks of radiotherapy is as good as five weeks – as well as being more convenient and less tiring for patients and cheaper for the health service.”

The study compared a three-week schedule of 15 treatments at a 40 Gy dose or 13 treatments at a 41.6 Gy or 39 Gy dose with a five-week, 25-treatment schedule at 50 Gy, which is the international standard. As a result of the START trial, the shorter treatment course of 15 treatments has been adopted in the UK since 2008, but the longer course is still used in many other countries.

Low radiotherapy doses had traditionally been used as scientists had originally believed that normal healthy breast tissue was more sensitive than tumour cells to the effects of radiotherapy, and that therefore small daily doses of radiotherapy were gentler on healthy tissues than cancer. But the trial has confirmed that cancer cells are just as sensitive to radiotherapy dose as healthy tissue – meaning that giving lower doses spared the cancer as much as the healthy tissue, and a higher dose could be more effective.

The same research team is now setting out to investigate whether even fewer treatments could be just as effective. A new Phase III randomised, controlled trial of 4,000 men and women called FAST-FORWARD will compare the three-week treatment regimen with two separate one-week schedules of slightly different doses.

Ms Haviland said: “The START trial had a huge impact on changing the standard of care for women with breast cancer in the UK, and increasingly around the world. Recruitment is already underway for a major new 15-year-long UK trial we are co-ordinating, to see if we can further improve treatment and spare both women and the health system the burden of extra treatments.”



The Institute of Cancer Research, London, is one of the world’s most influential cancer research institutes.

Scientists and clinicians at The Institute of Cancer Research (ICR) are working every day to make a real impact on cancer patients’ lives. Through its unique partnership with The Royal Marsden Hospital and ‘bench-to-bedside’ approach, the ICR is able to create and deliver results in a way that other institutions cannot. Together the two organisations are rated in the top four cancer centres globally.

The ICR has an outstanding record of achievement dating back more than 100 years. It provided the first convincing evidence that DNA damage is the basic cause of cancer, laying the foundation for the now universally accepted idea that cancer is a genetic disease. Today it leads the world at isolating cancer-related genes and discovering new targeted drugs for personalised cancer treatment. The Cancer Therapeutics Unit and Drug Development Unit at the ICR and The Royal Marsden were recently honoured with the 2012 American Association for Cancer Research Team Science Award for the “tremendous impact” of their preclinical and clinical studies.

As a college of the University of London, the ICR provides postgraduate higher education of international distinction. It has charitable status and relies on support from partner organisations, charities and the general public.

The Institute of Cancer Research’s Clinical Trials and Statistics Unit (ICR-CTSU) is an academic clinical trials unit accredited by the National Cancer Research Institute (NCRI) to conduct clinical trials into cancer treatments. The department is funded by an infrastructure grant from Cancer Research UK.

The ICR’s mission is to make the discoveries that defeat cancer. For more information visit 

The Royal Marsden NHS Foundation Trust

The Royal Marsden opened its doors in 1851 as the world’s first hospital dedicated to cancer diagnosis, treatment, research and education.

Today, together with its academic partner, The Institute of Cancer Research (ICR), it is the largest and most comprehensive cancer centre in Europe treating over 44,000 patients every year.  It is a centre of excellence with an international reputation for groundbreaking research and pioneering the very latest in cancer treatments and technologies. The Royal Marsden also provides community services in the London boroughs of Sutton and Merton and in June 2010, along with the ICR, the Trust launched a new academic partnership with Mount Vernon Cancer Centre in Middlesex.  

Since 2004, the hospital’s charity, The Royal Marsden Cancer Charity, has helped raise over £50 million to build theatres, diagnostic centres, and drug development units.

Prince William became President of The Royal Marsden in 2007, following a long royal connection with the hospital. For more information, visit

Cancer Research UK

  • Cancer Research UK is the world’s leading cancer charity dedicated to saving lives through research
  • The charity’s groundbreaking work into the prevention, diagnosis and treatment of cancer has helped save millions of lives.  This work is funded entirely by the public.
  • Cancer Research UK has been at the heart of the progress that has already seen survival rates in the UK double in the last forty years.
  • Cancer Research UK supports research into all aspects of cancer through the work of over 4,000 scientists, doctors and nurses.
  • Together with its partners and supporters, Cancer Research UK's vision is to beat cancer.

For further information about Cancer Research UK's work or to find out how to support the charity, please call 0300 123 1861 or visit Follow us on Twitter and Facebook

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