European Consensus on breast cancer radiotherapy published

Updated: Jan 19

A panel of European experts and patients has identified a way to achieve major changes in the way radiotherapy treatment for breast cancer patients is delivered around the world.

Research published in Lancet Oncology states that increased doses of radiotherapy over a shorter timeframe can be just as good as conventional treatment in preventing cancer returning but with far fewer treatment visits for patients.

In the clinical world Consensus statements can drive change – so this really is the next step to changing standard of care in Europe and the rest of the world.

Said Professor Charlotte Coles, Consultant Oncologist at Addenbrooke's and member of the expert panel.

The Consensus from ESTRO-ACROP: European Society of Therapeutic Radiology and Oncology - Advisory Committee in Radiation Oncology Practice, published online by Lancet Oncology, states that 3-week breast radiotherapy can be offered to any patient for any indication and 1-week breast radiotherapy can be offered for patients who do not need lymph node radiotherapy.

It follows months of work from the panel. They first looked at research on increased doses of radiation over a shorter timeframe (called hypofractionation), and then compiled consensus statements.

These were reviewed by experts from hospitals across Europe, Brazil and Israel, who graded how much they either agreed or disagreed with the statements.

Finally, the panel selected the statements that scored the highest and agreed a formal Consensus. Professor Coles added:

We knew the evidence was there to support hypofractionation – there have been some excellent clinical trials over the last couple of decades. These include the recent UK FAST-Forward trial that showed that 1-week breast radiotherapy is at least as good as conventional treatment in preventing cancer returning with similar side effects, but has far less treatment visits for patients

Hypofractionation is already standard of care in the UK, but it has been much slower to implement elsewhere. In addition, there are huge areas of the world, for example in parts of Africa, where access to radiotherapy treatment is extremely poor. Professor Coles explained:

There are other benefits too, including less travel for treatment, less time off work, less time in recovery.
What the Consensus is saying is that doctors could treat three breast cancer patients in the time that it used to take to treat just one, which would mean more patients could access breast radiotherapy.
The good things about reducing the number of weeks is we’re not giving less treatment, it’s the same treatment only over one week, in more concentrated doses.
The science behind it is based on how breast cancer reacts to hypofractionation, and it’s a happy consequence that it’s also quicker and cheaper

Professor Coles stated this it is the first time a consensus or guideline from ESTRO-ACROP has been published in a high-impact journal such as Lancet Oncology, which will help to influence policy makers and ensure equity of access to evidence-based radiotherapy.