Breast Cancer Coverage from Every Angle

Shortened Course of Radiotherapy for Breast Cancer: 5-Year Results From FAST-Forward Trial

By: Julia Fiederlein
Posted: Wednesday, May 27, 2020

The efficacy and safety of a shortened course of radiation therapy in larger doses for the treatment of breast cancer appear to be comparable to those of the conventional approach, according to John R. Yarnold, FRCR, of The Institute of Cancer Research (ICR), London, and colleagues. The 5-year follow-up data from the phase III FAST-Forward trial, published in The Lancet, may help to reduce the burden on the health-care system, particularly during the COVID-19 pandemic.

“We expect these findings will be incorporated into breast cancer treatment guidelines around the world, and we’re already seeing NHS hospitals wanting to move to the five-dose schedule because of the challenges they’re facing during the coronavirus pandemic,” coauthor Judith Bliss, MSc, also of ICR, commented in a press release.

The conventional approach irradiates patients with 40 Gy in 15 fractions over 3 weeks, whereas the hypofractionated approach delivers 26 Gy in 5 fractions over 1 week. Patients were randomly assigned to receive 40 Gy (n = 1,354), 26 Gy (n = 1,347), or 27 Gy in five fractions over 1 week (n = 1,355). The 5-year follow-up data included 3,681 patients.

The estimated cumulative incidences of ipsilateral breast tumor relapse up to 5 years after treatment in the 40-Gy, 26-Gy, and 27-Gy groups were 2.1%, 1.4%, and 1.7%, respectively. There appeared to be no significant difference in the incidence of locoregional relapse, distant relapse, disease-free survival, overall survival, and adverse events between the groups. Moderate or marked tissue effects at 5 years were reported in 9.9% of patients who received 40-Gy treatment, 11.9% of patients who received 26-Gy treatment, and 15.4% of patients given 27-Gy treatment, with no statistically significant difference between the 40-Gy and the 26-Gy groups (P = .17). The investigators proposed that the 26-Gy approach is safe and noninferior to the conventional approach.

Disclosure: For full disclosures of the study authors, visit

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