Breast Radiotherapy Reduced to More Convenient Once-Weekly Regimen Option

An investigational regimen of once-weekly breast irradiation following lumpectomy is more convenient to patients at a lower cost, results in better completion rates of prescribed radiation treatment, and generates cosmetic outcomes comparable to the current routine of daily radiation.

These interim findings of the five-year phase II clinical trial were presented at the Breast Cancer Symposium 2014, held in San Francisco (CA, USA), in September 2014, by Anthony E. Dragun, MD, vice chair and associate professor of radiation oncology at the University of Louisville (UofL; KY, USA).

Dr. Dragun, a radiation oncologist with University of Louisville Physicians, launched the trial three years ago at UofL’s James Graham Brown Cancer Center, a part of KentuckyOne Health and the only site offering the experimental regimen in the United States. A second KentuckyOne Health site is being planned, he noted, and is expected to begin enrolling patients in the upcoming months.

Reviewing data from Europe, in particular the United Kingdom, Dr. Dragun discovered an alternative to the currently standard daily radiation treatments prescribed to patients after a lumpectomy. Physicians in the United Kingdom and other European countries were reporting excellent results with a regimen of radiation administered once-weekly. “Instead of daily treatments for 25–30 days, five to six treatments administered once each week were being used,” he said. “I thought this regimen would give our patients here in Kentucky a great deal of access and choice, so we developed the trial and launched it in 2011.”

Approximately 150 female patients have been enrolled in the trial up to now, Dr. Dragun reported. Patients undergoing a lumpectomy following diagnosis of breast cancer are offered a choice of the current standard of daily radiation treatments or the option to enroll in the trial and receive treatment once a week. The radiotherapy dosing has been adjusted to compensate for the change in how the sessions are administered, but no adverse effects have been seen, Dr. Dragun said. “The outcomes with once-weekly treatments are absolutely in line with what we see in daily breast irradiation,” he said. “The standard of care is maintained.”

Giving women the choice of how their treatment is administered means more women complete their treatment, he said. “Finding time for daily treatments for six weeks or more just isn’t possible for many women,” Dr. Dragun stated. “Scheduling once-weekly treatments is much easier to fit into the busy lives our patients lead. We also see many patients who depend on public transportation or live in rural areas that are 30 miles or more from our center, and they have told us that they would not have been able to complete a traditional course of daily radiation treatment. Their only alternative would be a mastectomy.”

Because radiation treatment is reimbursed on a per-treatment basis, Dr. Dragun reported that the overall cost is lowered. “We have reduced the number of treatments to about one-fourth to one-third of what the current daily treatment regimen is,” he said. “[US] Medicare reimburses radiation costs on a per-treatment basis, and most private insurers do likewise. This means we’ve been able to reduce the cost by 50%–60% without jeopardizing the quality of care.”

Dr. Dragun is planning to enroll another 50 patients at the Louisville site and 30 at the future trial site. After the completion of this trial, he intends to expand into a multicenter phase III trial at facilities in other US states. “We believe the once-weekly regimen such as this will become a standard option in the next decade,” he said.

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