Less Can Be More With Hypofractionation Radiation Therapy for Breast Cancer

In recent years, cancer physicians and radiation oncologists have been whittling away at the length of time for radiation treatment. The goal: to make radiation treatment more convenient for the patient, with less side effects -- while maintaining radiation treatment as a powerful therapy that can greatly reduce cancer recurrence.

Convenience is an important issue for patients receiving radiation therapy. At one time, patients would undergo treatments Monday through Friday for five to six and a half weeks, depending on their type of breast cancer.

Under a method of therapy called hypofractionation, however, patients now can undergo treatments daily for three to four weeks.

The result? The same chance of cancer returning and fewer trips to the radiation suite, resulting in more convenience for patients, less pain and less skin changes.

Time-Tested Treatment

Hypofractionation radiation was introduced about 10 years ago after several studies, done mostly in other countries, looked at a shorter course of radiation and compared it to the standard treatment, says UH Seidman radiation oncologist Janice Lyons, MD.

“They found that the cure rate – or the chance that the cancer will come back – is exactly the same whether a patient undergoes five to six weeks of treatment or three to four weeks of treatment,” Dr. Lyons says. “But the cosmetic outcome, the quality of life, and pain is actually less with fewer treatments. That’s a win-win.”

About a year ago, several studies came out looking at even shorter courses of radiation called ultra-hypofractionation – five treatments delivered in different ways depending on the patient and the circumstances. For example, a patient might receive a treatment once a week over five weeks.

“What we found from those studies is that, again, the recurrence risk is the same,” Dr. Lyons says. “There might be a little bit more swelling in the breast for some patients. But as long as we can get a good radiation plan, it’s comparable results for eligible patients with an even shorter course of treatment.”

There is some emerging data that there is actually less cancer-related fatigue during radiation with ultra-hypofractionation, Dr. Lyons says. “So there’s probably an additional benefit in energy level for women undergoing care.”

Best Candidates for Hypofractionation

A patient’s age and individual cancer diagnosis determines whether ultra-hypofractionation is appropriate therapy. The women who were in the studies were older women with small, low-to-intermediate grade, estrogen-responsive cancers without lymph node involvement.

“So it’s mostly women over the age of 60 with very good prognostic breast cancers for whom we use some of these ultra-hypofractionated schedules. According to Dr. Lyons, “It’s possible that down the road, once we have longer follow-up in a broader cohort of patients, there will be studies to suggest it is appropriate for younger women or women with lymph node involvement.”

Hypofractionation and ultra-hypofractionation are most appropriate for women who undergo breast conservation surgery or have very low-risk breast cancers and keep their breasts.

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The breast cancer team at UH Seidman Cancer Center provides comprehensive care throughout the patient journey, from breast cancer screening and diagnosis, to the development and implementation of advanced treatment plans to recovery and survivorship. Our fellowship-trained cancer doctors offer the very latest in medical and surgical advancements in breast cancer care for men and women. Learn more about breast cancer services at UH Seidman Cancer Center.