MONDAY, Sept. 30, 2024 (HealthDay News) — A shorter course of radiation after mastectomy does not jeopardize a patient’s chances of successful breast reconstruction, a new study finds.
About 40 percent of people with breast cancer undergo mastectomies, followed by five to six weeks of radiation therapy to kill any cancer cells that may remain in the chest wall or lymph nodes. Most opt for breast reconstruction.
“Over the last 10 years, we have tried to move all patients who need breast radiation to a shorter, more convenient schedule,” said lead researcher Dr. Matthew Poppe, a professor of radiation oncology at the University of Utah. “But post-mastectomy patients planning breast reconstruction were the only group in which we did not have enough data to support shorter courses.”
The large Phase 3 trial shows that treatment time can be reduced to three weeks without compromising patients’ reconstruction surgery, he said.
The findings were presented Sunday at the American Society for Radiation Oncology annual meeting in Washington, D.C.
The researchers described the study as the first international effort to show that a shorter course of radiation after mastectomy is safe and effective.
They said cutting treatment time almost in half (from 25 to 16 sessions) could make post-mastectomy radiation a more accessible option for patients.
Other research has shown that shorter treatment is not only just as effective in preventing cancer from coming back, but also improves the patient’s quality of life. But those studies generally excluded patients seeking breast reconstruction, out of concern that higher daily doses of radiation could impair the reconstructive process and increase side effects.
The new study investigated whether that would be the case. It included 898 patients at 209 cancer centers in the United States and Canada. Some had smaller tumors, others larger and had spread to nearby lymph nodes. Their average age: 46, meaning half were younger and half were older.
Half received five weeks of conventional radiation, the other half received a higher dose for three weeks. In total, 51% received chemotherapy before their mastectomies and 37% afterward.
The 650 patients who underwent breast reconstruction during the study period were followed for a median of five years. Researchers documented complications, such as problems with wound healing, failures in reconstruction, or formation of scar tissue affecting the new breast.
Two years after breast reconstruction, 14% of patients who received the shorter, more intense course of radiation had complications, compared with 12% who received standard treatment. Side effects were mild for both groups.
“We expected a complication rate of 25 to 35 percent based on previous single-institution studies of patients who received reconstructive surgery and radiation,” said the study’s lead author, Dr. Atif Khan, a radiation oncologist at the Center Memorial Sloan Kettering Cancer Center in New York City.
“It was very exciting to see a complication rate that was almost half of what we anticipated,” he added in a news release from the meeting.
Regardless of the treatment program, patients whose breasts were reconstructed with their own tissue had fewer complications than those who received implants: 8.7 percent versus 15.5 percent.
Three years after treatment, the groups had similar rates of cancer recurrence: 1.5 percent in patients who underwent a shorter course of radiation and 2.3 percent in those who received traditional treatment.
Without radiation, recurrence rates after a mastectomy range from 20 to 30 percent for high-risk patients, according to Khan.
The shorter course of treatment saves patients time and money, and Poppe said he has already seen the benefit in his patients’ lives.
The researchers hope their findings will lead more cancer centers to offer a shorter course of radiation for mastectomy patients.
“There has been a slow start to moving to shorter treatment courses after mastectomy, even without reconstruction,” Poppe said. “But we now have solid data, from hundreds of academies and community centers, and from patients with any type of reconstruction, that clearly show the safety and effectiveness of short-course radiation.”
Because these findings were presented at a medical meeting, they should be considered preliminary until they are published in a peer-reviewed journal.
More information
The American Society of Plastic Surgeons has more information about breast reconstruction.
SOURCE: American Society for Radiation Oncology, news release, September 30, 2024
