New guidance for fast-track breast cancer radiotherapy treatment

Thursday 13 May 2021

Cancer experts from across the UK have supported the roll out of fast-track radiotherapy for patients with breast cancer, via a series of new consensus statements to inform clinical practice.

Published today by The Royal College of Radiologists (RCR), the consensus statements on the use of hypofractionation – shorter, more intense courses of radiotherapy treatment – reflect new research on radiotherapy dosing for breast cancer following surgery, as well as the urgent adoption that has taken place during the coronavirus pandemic.

Results from the UK’s FAST-Forward trial – published in April 2020 as the COVID-19 pandemic started to escalate – revealed that using higher doses of radiotherapy over five days for post-operative breast cancer patients was as safe and effective as using lower doses over a three week course.

The trial findings were quickly put into practice for many patients in UK cancer centres and were welcomed as a way of also reducing patient hospital attendances at the height of the pandemic.

To reflect these rapid changes, the RCR’s Clinical Oncology Faculty sought to create new expert consensus statements, acting as an update to the RCR’s existing 2016 statements on adjuvant radiotherapy for breast cancer.

The statements are aimed at the cancer care community to help reduce clinical variation between providers. Breast radiotherapy leads from centres across the UK – and their teams – input into the drafting of the hypofractionation statements in summer 2020, before voting on them in October.

The seven new statements give community agreement that fast-track treatment should be explicitly offered, or considered, for specific types of patient and radiotherapy needs. For example, they state that short-course treatment should be offered to patients needing whole breast, chest wall and partial breast radiotherapy.   

Dr Tom Roques, the RCR’s Medical Director of Professional Practice for Clinical Oncology, said:

“The UK-run FAST-Forward trial has shown that one week of radiotherapy for breast cancer  is as effective as treatment for three weeks.

“That is great news for patients who can benefit from reduced time at hospital having treatment. In the pandemic that reduces risk from coronavirus but more importantly it enables them to continue with their normal lives more easily.

“Our consensus statements should ensure that all suitable patients have the opportunity to benefit from this research in their own local cancer centre.”

Hilary Stobart, a previous breast radiotherapy patient and advisor to the consensus project, said:

“The patient team involved in the project hope that these statements mean that all treatment centres up and down the UK can continue to offer one week breast radiotherapy, even after COVID-19.

“This change in practice is great news, meaning that many of us can safely finish our radiotherapy sooner.

“Hypofractionated treatment will save on travel and time and allow patients to get back to our normal lives much sooner."

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