Treatment times for radiotherapy could be reduced for some early breast cancer patients, according to a trial led by Addenbrooke's consultant oncologist, Professor Charlotte Coles.
Results from the IMPORT HIGH trial, published in The Lancet and funded by Cancer Research UK, show that giving some breast cancer patients a targeted additional dose of radiotherapy at the same time as treatment to the whole breast (known as simultaneous integrated boost or SIB) cuts the time taken to complete treatment by at least one week.
Targeted cancer treatments and precision breast cancer medicine underpins the focus of care offered at our new Cambridge Cancer Research Hospital.
The state-of-the-art facility will house three world-leading research institutes focused on detecting cancer earlier, integrated cancer medicine and personalised breast cancer treatment.
The IMPORT HIGH trial, led by University of Cambridge and The Institute of Cancer Research, London, found that SIB radiotherapy given at the right dose works just as well as existing radiotherapy techniques in reducing the risk of the cancer returning in the treated breast.
In total, 2,617 patients at 76 centres took part in the trial, including Addenbrooke's patient Helen Lee (46), from Mepal near Cambridge.
In October 2013, Helen first noticed an unusual twinge in her right breast, so her GP referred her to the Breast Unit at Addenbrooke’s Hospital for a mammogram.
But, at the age of 36, she was diagnosed with breast cancer. The breast screening procedure revealed a tumour just over 2cm in size located deep in her breast tissue. Helen said:
“I felt quite relieved because I knew there was something wrong. I was really lucky, otherwise I would have come in at 51 years-old for screening and it might not have been treatable by then.”
Helen had surgery a few weeks after her diagnosis, followed by a course of chemotherapy. When she was due to begin radiotherapy treatment she was asked if she would like to take part in the IMPORT HIGH trial.
Helen was assigned to a group receiving a targeted radiotherapy boost delivered simultaneously during her whole breast radiotherapy treatment, which reduced her treatment from 23 sessions over 4.5 weeks to 15 sessions over 3 weeks.
It makes a huge, huge difference to speak to people who can help me with things that other people wouldn't understand.
Helen Lee, Addenbrooke's patient
Helen said: “I was happy to sign up for the IMPORT HIGH trial because they explained that it was how they'd like to do radiotherapy in the future.
“I feel like I've had a more supported journey through my treatment from having been on a trial, because I've had 10 years of follow-up appointments. It makes a huge, huge difference to speak to people who can help me with things that other people wouldn't understand.”
After undergoing surgery, chemotherapy and radiotherapy treatment, Helen has now been clear of cancer for nearly 10 years.
How the trial worked
In the trial, patients were divided into three groups.
The first group received whole breast radiotherapy with a sequential boost over 4.5 weeks in total - what currently happens.
The second and third groups each received two different doses of SIB radiotherapy. Patients received whole breast radiotherapy with a simultaneous boost of either lower or higher dose a dose - over 3 weeks in total. There was no advantage shown for those who received the higher boost dose, it also led to slightly increased rates of side effects.
Researchers hope that SIB radiotherapy could reduce the costs for patients travelling to hospital and cut the time taken to undergo treatment and recovery.
By delivering more targeted boost radiotherapy over shorter time periods, women can get on with their lives more quickly.
Professor Charlotte Coles
Professor Charlotte Coles, an oncology consultant at Addenbrooke’s Hospital, CRUK RadNet Cambridge lead and chief investigator for the trial, said:
“Some women have to live with permanent breast changes after radiotherapy which may affect their well-being. With SIB, we can deliver high-quality effective radiotherapy whilst minimising toxicity from it.
“This is a careful step towards even shorter courses of radiotherapy that include more complex techniques. By delivering more targeted boost radiotherapy over shorter time periods, women can get on with their lives more quickly”.
At a time when health services across the UK are facing chronic staff shortages in cancer services, we need to look at new ways to get more patients treated as quickly as possible.
Michelle Mitchell, Chief Executive of Cancer Research UK
Cancer reaccurance
The chance of the cancer returning to the treated breast remained very low in the IMPORT HIGH trial after 5 years across all treatment groups.
Patients given the lower dose of SIB radiotherapy reported similar rates of side-effects, like breast hardening or firmness, as those who received the standard sequential radiotherapy schedule.
Currently, women with a higher than average risk of cancer coming back in their treated breast are given an additional radiotherapy dose to the original site of the tumour after radiotherapy is given to the entire breast. This approach, known as sequential boost, maximises the chances that any remaining cancer cells are removed from the breast.
But it takes longer for women to complete sequential boost radiotherapy, requiring them to attend more hospital appointments.
Chief Executive of Cancer Research UK, Michelle Mitchell, said:
"At a time when health services across the UK are facing chronic staff shortages in cancer services, we need to look at new ways to get more patients treated as quickly as possible.
"In addition to training up more staff, more precise forms of radiotherapy can help to reduce the number of people who are waiting too long to begin vital treatment.
“Trials like IMPORT HIGH are leading the way in delivering smarter radiotherapy with existing technology. We hope that treatment centres across the UK and globally will rapidly adopt this approach to beat breast cancer sooner and give patients more precious time with their loved ones."
Since Helen's diagnosis and treatment, she has taken part regularly in Cancer Research UK Race for Life, Pretty Muddy and Shine Night Walk events in Cambridge, Bedford and Stamford, fundraising for life-saving research into future treatments for cancer patients.
Additional funding for research arising from the IMPORT HIGH trial is provided by the The National institute of Health and Care Research (NIHR).
For further information about the trial and its results, you can read more here: https://doi.org/10.1016/S0140-6736(23)00619-0 (opens in a new tab)