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Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer

Brunt, Adrian Murray; Haviland, Joanne S.; Sydenham, Mark; Agrawal, Rajiv K.; Algurafi, Hafiz; Alhasso, Abdulla; Barrett-Lee, Peter; Bliss, Peter; Bloomfield, David; Bowen, Joanna; Donovan, Ellen; Goodman, Andy; Harnett, Adrian; Hogg, Martin; Kumar, Sri; Passant, Helen; Quigley, Mary; Sherwin, Liz; Stewart, Alan; Syndikus, Isabel; Tremlett, Jean; Tsang, Yat; Venables, Karen; Wheatley, Duncan; Bliss, Judith M.; Yarnold, John R.

Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer Thumbnail


Authors

Joanne S. Haviland

Mark Sydenham

Rajiv K. Agrawal

Hafiz Algurafi

Abdulla Alhasso

Peter Barrett-Lee

Peter Bliss

David Bloomfield

Joanna Bowen

Ellen Donovan

Andy Goodman

Adrian Harnett

Martin Hogg

Sri Kumar

Helen Passant

Mary Quigley

Liz Sherwin

Alan Stewart

Isabel Syndikus

Jean Tremlett

Yat Tsang

Karen Venables

Duncan Wheatley

Judith M. Bliss

John R. Yarnold



Abstract

PURPOSE: Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr regimens. Ten-year results are presented.

METHODS: Women = 50 years of age with low-risk invasive breast carcinoma (pT1-2 pN0) were randomly assigned to 50 Gy/25 fr (5 weeks) or 30 or 28.5 Gy in 5 once-weekly fr of 6.0 or 5.7 Gy. The primary end point was change in photographic breast appearance at 2 and 5 years; secondary end points were physician assessments of NTE and local tumor control. Odds ratios (ORs) from longitudinal analyses compared regimens.

RESULTS: A total of 915 women were recruited from 18 UK centers (2004-2007). Five-year photographs were available for 615/862 (71%) eligible patients. ORs for change in photographic breast appearance were 1.64 (95% CI, 1.08 to 2.49; P = .019) for 30 Gy and 1.10 (95% CI, 0.70 to 1.71; P = .686) for 28.5 Gy versus 50 Gy. a/ß estimate for photographic end point was 2.7 Gy (95% CI, 1.5 to 3.9 Gy), giving a 5-fr schedule of 28 Gy (95% CI, 26 to 30 Gy) estimated to be isoeffective with 50 Gy/25 fr. ORs for any moderate/marked physician-assessed breast NTE (shrinkage, induration, telangiectasia, edema) were 2.12 (95% CI, 1.55 to 2.89; P < .001) for 30 Gy and 1.22 (95% CI, 0.87 to 1.72; P = .248) for 28.5 Gy versus 50 Gy. With 9.9 years median follow-up, 11 ipsilateral breast cancer events (50 Gy: 3; 30 Gy: 4; 28.5 Gy: 4) and 96 deaths (50 Gy: 30; 30 Gy: 33; 28.5 Gy: 33) have occurred.

CONCLUSION: At 10 years, there was no significant difference in NTE rates after 28.5 Gy/5 fr compared with 50 Gy/25 fr, but NTE were higher after 30 Gy/5 fr. Results confirm the published 3-year findings that a once-weekly 5-fr schedule of whole-breast radiotherapy can be identified that appears to be radiobiologically comparable for NTE to a conventionally fractionated regimen.

Report Type Other
Acceptance Date May 19, 2020
Online Publication Date Jul 14, 2020
Publication Date Oct 1, 2020
Publicly Available Date Mar 29, 2024
Publisher American Society of Clinical Oncology
Pages 3261-3272
DOI https://doi.org/10.1200/jco.19.02750
Publisher URL https://doi.org/10.1200/jco.19.02750
Additional Information Protocol paper