Thanks for finding it, Karen. Yes, that's it. In order to copy any of the abstracts to pass along here you click on the resources at
www.sabcs.org, put in your user name and pass word for conference attendees (on the back of your conference badge or you can contact the SABCS folks if you tossed it), then onto the abstracts, slides, etc and away ya go.
If I was about to get radiation or in the midst of it I would copy this abstract and bring it to my radiologist and ask about it. Not that I'm an expert or anything but this looks at a 10 year followup and seems significant enough to consider---ESPECIALLY if it's the reduction in the money holding radioloogists back from adopting this standard of care like the doc at the mentorring session mentioned. The abstract says longer term studies are neccessary. Of course nobody wants to short themselves and not get enough radiation to get the job done adequately. UK ladies---how many treatment did you have? The comparison group in this study is 5 weeks versus 3 weeks, not 6 weeks like many of us got with 'boosts".
Whatdaya think of this study?
Paula
[S4-1] The UK START (Standardisation of Breast Radiotherapy) Trials: 10-Year Follow-Up Results
Haviland JS, Agrawal R, Aird E, Barrett J, Barrett-Lee P, Brown J, Dewar J, Dobbs J, Hopwood P, Hoskin P, Lawton P, Magee B, Mills J, Morgan D, Owen R, Simmons S, Sydenham M, Venables K, Bliss JM, Yarnold JR, On Behalf of the START Trialists. The Institute of Cancer Research, Sutton, United Kingdom; Shrewsbury and Telford Hospital NHS Trust, United Kingdom; Mount Vernon Hospital, Northwood, United Kingdom; Royal Berkshire NHS Foundation Trust, Reading, United Kingdom; Velindre Hospital NHS Trust, Cardiff, United Kingdom; previously University of Bristol, now Eli Lilly & Company, United Kingdom; Formerly Ninewells Hospital, Dundee, United Kingdom; Formerly Guys and St Thomas' NHS Trust, London, United Kingdom; Nottingham City Hospital, United Kingdom; Formerly The Christie NHS Foundation Trust, Manchester, United Kingdom; Formerly Nottingham University Hospital NHS Trust, United Kingdom; Formerly Cheltenham General Hospital, United Kingdom; The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
Background International standard adjuvant radiotherapy regimens following primary surgery for early breast cancer have historically delivered a high total dose (50Gy) in 25 small daily doses (fractions) over 5 weeks, however randomised trials, including START, indicate that a lower total dose delivered in fewer, larger fractions (Fr) is likely to be at least as safe and effective (START Trialists' Group, Lancet 2008 & Lancet Oncol 2008). With patients remaining at risk of local relapse for many years, information on long-term outcomes is needed to provide confidence in clinical practice. Here, we report 10-year follow-up of the UK START Trials testing 13- and 15-Fr regimens in terms of local cancer control and late adverse effects.
Methods Between 1999 and 2002, 4451 women with completely excised invasive breast cancer (T1-3, N0-1, M0) were randomised after primary surgery to comparisons of 50Gy in 25Fr over 5 weeks vs 41·6Gy or 39Gy in 13Fr over 5 weeks (START A), or 50Gy in 25Fr over 5 weeks vs 40Gy in 15Fr over 3 weeks (START B). Women were eligible if aged over 18 years and did not have an immediate surgical reconstruction. Protocol-specified principal endpoints were local-regional (LR) tumour relapse and late normal tissue effects. Analysis was by intention to treat.
Findings Median follow-up in survivors is now 9.3 years in START A and 9.9 years in START B, with 139 LR relapses in START A and 95 in START B. In START A, the 10-year rate of LR relapse was 7.4% (95%CI 5.5-10.0) after 50Gy, 6.3% (95%CI 4.7-8.5) after 41·6Gy and 8.8% (95%CI 6.7-11.4) after 39Gy. In START B, the 10-year rate of LR relapse was 5.5% (95%CI 4.2-7.2) after 50Gy and 4.3% (95%CI 3.2-5.9) after 40Gy. Clinician assessments suggested lower 10-year rates of any moderate/marked late normal tissue effects after 39Gy (43.9%; 95%CI 39.3-48.7) and similar rates after 41.6Gy (49.5%; 95%CI 44.9-54.3) compared with 50Gy (50.4%; 95%CI 45.8-55.3) in START A and lower rates after 40Gy in START B (37.9%; 95%CI 34.5-41.5) compared with 50Gy (45.3%; 95%CI 41.7-49.0). From a planned meta-analysis of START A and the START pilot trial (Owen et al, Lancet Oncol 2006), the adjusted estimate of α/β value for tumour control was 3.5Gy (95% CI 1.2-5.7) and for late change in photographic breast appearance was 3.1Gy (95% CI 2.0-4.2).
Interpretation Long-term follow-up confirms that breast cancer and the surrounding dose-limiting healthy tissues respond similarly to radiotherapy fraction size and thus that appropriately-dosed hypofractionated radiotherapy is safe and effective in treatment of patients with early breast cancer. 41·6Gy in 13Fr and 40Gy in 15Fr each appear comparable to 50Gy in 25Fr in terms of local-regional tumour control and late normal tissue effects. These results support the continued use of 40Gy in 15Fr as standard of care (UK NICE Guidance 2009) for women requiring adjuvant radiotherapy for early breast cancer.
Thursday, December 6, 2012 3:15 PM
General Session 4 (3:15 PM-5:00 PM)
Linear Mode
