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Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer

PURPOSE: Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr regimens. Ten-year results are prese...

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Autores principales: Brunt, Adrian Murray, Haviland, Joanne S., Sydenham, Mark, Agrawal, Rajiv K., Algurafi, Hafiz, Alhasso, Abdulla, Barrett-Lee, Peter, Bliss, Peter, Bloomfield, David, Bowen, Joanna, Donovan, Ellen, Goodman, Andy, Harnett, Adrian, Hogg, Martin, Kumar, Sri, Passant, Helen, Quigley, Mary, Sherwin, Liz, Stewart, Alan, Syndikus, Isabel, Tremlett, Jean, Tsang, Yat, Venables, Karen, Wheatley, Duncan, Bliss, Judith M., Yarnold, John R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Society of Clinical Oncology 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526720/
https://www.ncbi.nlm.nih.gov/pubmed/32663119
http://dx.doi.org/10.1200/JCO.19.02750
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author Brunt, Adrian Murray
Haviland, Joanne S.
Sydenham, Mark
Agrawal, Rajiv K.
Algurafi, Hafiz
Alhasso, Abdulla
Barrett-Lee, Peter
Bliss, Peter
Bloomfield, David
Bowen, Joanna
Donovan, Ellen
Goodman, Andy
Harnett, Adrian
Hogg, Martin
Kumar, Sri
Passant, Helen
Quigley, Mary
Sherwin, Liz
Stewart, Alan
Syndikus, Isabel
Tremlett, Jean
Tsang, Yat
Venables, Karen
Wheatley, Duncan
Bliss, Judith M.
Yarnold, John R.
author_facet Brunt, Adrian Murray
Haviland, Joanne S.
Sydenham, Mark
Agrawal, Rajiv K.
Algurafi, Hafiz
Alhasso, Abdulla
Barrett-Lee, Peter
Bliss, Peter
Bloomfield, David
Bowen, Joanna
Donovan, Ellen
Goodman, Andy
Harnett, Adrian
Hogg, Martin
Kumar, Sri
Passant, Helen
Quigley, Mary
Sherwin, Liz
Stewart, Alan
Syndikus, Isabel
Tremlett, Jean
Tsang, Yat
Venables, Karen
Wheatley, Duncan
Bliss, Judith M.
Yarnold, John R.
author_sort Brunt, Adrian Murray
collection PubMed
description PURPOSE: Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr regimens. Ten-year results are presented. METHODS: Women ≥ 50 years of age with low-risk invasive breast carcinoma (pT1-2 pN0) were randomly assigned to 50 Gy/25 fr (5 weeks) or 30 or 28.5 Gy in 5 once-weekly fr of 6.0 or 5.7 Gy. The primary end point was change in photographic breast appearance at 2 and 5 years; secondary end points were physician assessments of NTE and local tumor control. Odds ratios (ORs) from longitudinal analyses compared regimens. RESULTS: A total of 915 women were recruited from 18 UK centers (2004-2007). Five-year photographs were available for 615/862 (71%) eligible patients. ORs for change in photographic breast appearance were 1.64 (95% CI, 1.08 to 2.49; P = .019) for 30 Gy and 1.10 (95% CI, 0.70 to 1.71; P = .686) for 28.5 Gy versus 50 Gy. α/β estimate for photographic end point was 2.7 Gy (95% CI, 1.5 to 3.9 Gy), giving a 5-fr schedule of 28 Gy (95% CI, 26 to 30 Gy) estimated to be isoeffective with 50 Gy/25 fr. ORs for any moderate/marked physician-assessed breast NTE (shrinkage, induration, telangiectasia, edema) were 2.12 (95% CI, 1.55 to 2.89; P < .001) for 30 Gy and 1.22 (95% CI, 0.87 to 1.72; P = .248) for 28.5 Gy versus 50 Gy. With 9.9 years median follow-up, 11 ipsilateral breast cancer events (50 Gy: 3; 30 Gy: 4; 28.5 Gy: 4) and 96 deaths (50 Gy: 30; 30 Gy: 33; 28.5 Gy: 33) have occurred. CONCLUSION: At 10 years, there was no significant difference in NTE rates after 28.5 Gy/5 fr compared with 50 Gy/25 fr, but NTE were higher after 30 Gy/5 fr. Results confirm the published 3-year findings that a once-weekly 5-fr schedule of whole-breast radiotherapy can be identified that appears to be radiobiologically comparable for NTE to a conventionally fractionated regimen.
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spelling pubmed-75267202021-10-01 Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer Brunt, Adrian Murray Haviland, Joanne S. Sydenham, Mark Agrawal, Rajiv K. Algurafi, Hafiz Alhasso, Abdulla Barrett-Lee, Peter Bliss, Peter Bloomfield, David Bowen, Joanna Donovan, Ellen Goodman, Andy Harnett, Adrian Hogg, Martin Kumar, Sri Passant, Helen Quigley, Mary Sherwin, Liz Stewart, Alan Syndikus, Isabel Tremlett, Jean Tsang, Yat Venables, Karen Wheatley, Duncan Bliss, Judith M. Yarnold, John R. J Clin Oncol ORIGINAL REPORTS PURPOSE: Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr regimens. Ten-year results are presented. METHODS: Women ≥ 50 years of age with low-risk invasive breast carcinoma (pT1-2 pN0) were randomly assigned to 50 Gy/25 fr (5 weeks) or 30 or 28.5 Gy in 5 once-weekly fr of 6.0 or 5.7 Gy. The primary end point was change in photographic breast appearance at 2 and 5 years; secondary end points were physician assessments of NTE and local tumor control. Odds ratios (ORs) from longitudinal analyses compared regimens. RESULTS: A total of 915 women were recruited from 18 UK centers (2004-2007). Five-year photographs were available for 615/862 (71%) eligible patients. ORs for change in photographic breast appearance were 1.64 (95% CI, 1.08 to 2.49; P = .019) for 30 Gy and 1.10 (95% CI, 0.70 to 1.71; P = .686) for 28.5 Gy versus 50 Gy. α/β estimate for photographic end point was 2.7 Gy (95% CI, 1.5 to 3.9 Gy), giving a 5-fr schedule of 28 Gy (95% CI, 26 to 30 Gy) estimated to be isoeffective with 50 Gy/25 fr. ORs for any moderate/marked physician-assessed breast NTE (shrinkage, induration, telangiectasia, edema) were 2.12 (95% CI, 1.55 to 2.89; P < .001) for 30 Gy and 1.22 (95% CI, 0.87 to 1.72; P = .248) for 28.5 Gy versus 50 Gy. With 9.9 years median follow-up, 11 ipsilateral breast cancer events (50 Gy: 3; 30 Gy: 4; 28.5 Gy: 4) and 96 deaths (50 Gy: 30; 30 Gy: 33; 28.5 Gy: 33) have occurred. CONCLUSION: At 10 years, there was no significant difference in NTE rates after 28.5 Gy/5 fr compared with 50 Gy/25 fr, but NTE were higher after 30 Gy/5 fr. Results confirm the published 3-year findings that a once-weekly 5-fr schedule of whole-breast radiotherapy can be identified that appears to be radiobiologically comparable for NTE to a conventionally fractionated regimen. American Society of Clinical Oncology 2020-10-01 2020-07-14 /pmc/articles/PMC7526720/ /pubmed/32663119 http://dx.doi.org/10.1200/JCO.19.02750 Text en © 2020 by American Society of Clinical Oncology https://creativecommons.org/licenses/by/4.0/ Licensed under the Creative Commons Attribution 4.0 License: https://creativecommons.org/licenses/by/4.0/
spellingShingle ORIGINAL REPORTS
Brunt, Adrian Murray
Haviland, Joanne S.
Sydenham, Mark
Agrawal, Rajiv K.
Algurafi, Hafiz
Alhasso, Abdulla
Barrett-Lee, Peter
Bliss, Peter
Bloomfield, David
Bowen, Joanna
Donovan, Ellen
Goodman, Andy
Harnett, Adrian
Hogg, Martin
Kumar, Sri
Passant, Helen
Quigley, Mary
Sherwin, Liz
Stewart, Alan
Syndikus, Isabel
Tremlett, Jean
Tsang, Yat
Venables, Karen
Wheatley, Duncan
Bliss, Judith M.
Yarnold, John R.
Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer
title Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer
title_full Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer
title_fullStr Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer
title_full_unstemmed Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer
title_short Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer
title_sort ten-year results of fast: a randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer
topic ORIGINAL REPORTS
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526720/
https://www.ncbi.nlm.nih.gov/pubmed/32663119
http://dx.doi.org/10.1200/JCO.19.02750
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