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Five-fraction Radiotherapy for Breast Cancer: FAST-Forward to Implementation.

A M Brunt1, J S Haviland2, A M Kirby3

  • 1David Weatherall Building, School of Medicine, University of Keele, Keele, UK; Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK.

Clinical Oncology (Royal College of Radiologists (Great Britain))
|May 23, 2021
PubMed
Summary
This summary is machine-generated.

The FAST-Forward trial found that a 26 Gy radiotherapy schedule in 5 fractions is non-inferior to a 40 Gy schedule in 15 fractions for breast cancer patients, with similar normal tissue effects. This shorter regimen is recommended for clinical implementation.

Keywords:
Breast cancerhypofractionationnon-inferiority RCTradiobiologyradiotherapytumour control

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Area of Science:

  • Oncology
  • Radiotherapy
  • Clinical Trials

Background:

  • The FAST-Forward trial investigated accelerated partial breast irradiation (APBI) schedules.
  • Conventional APBI involves 40 Gy in 15 fractions over 3 weeks.
  • Shorter, intensified schedules are being explored to improve patient convenience and resource utilization.

Purpose of the Study:

  • To compare the efficacy and safety of a 26 Gy schedule delivered in 5 fractions over 1 week versus the standard 40 Gy in 15 fractions over 3 weeks for breast radiotherapy.
  • To assess the rates of ipsilateral breast tumour relapse (IBTR) and normal tissue effects (NTE).

Main Methods:

  • Phase 3 randomized controlled trial (FAST-Forward) involving approximately 4000 patients.
  • Comparison of two radiotherapy schedules: 26 Gy in 5 fractions (1 week) vs. 40 Gy in 15 fractions (3 weeks).
  • Evaluation of 5-year IBTR and clinician-assessed NTE.

Main Results:

  • Non-inferiority in 5-year IBTR was demonstrated for both 26 Gy (1.4%) and 27 Gy (1.7%) schedules compared to 40 Gy (2.1%).
  • Subgroup analyses showed no significant differential effect on IBTR or NTE based on patient or tumour characteristics.
  • Low rates of moderate/marked NTE were observed, predominantly moderate, with no significant difference between schedules.

Conclusions:

  • The 26 Gy in 5 fractions schedule is recommended for clinical implementation due to its non-inferiority to the 40 Gy schedule and similar safety profile.
  • This accelerated regimen offers a more convenient treatment option for breast cancer patients.
  • Further research may explore radiobiological implications of time-related effects in radiotherapy schedules.