Breast cancer in young women, what is the best dose of radiotherapy to prevent recurrence and save aesthetics?

There standard dose of radiotherapy prescribed to young patients with breast cancer is the correct one and increasing it would not significantly reduce the risks of recurrence, while it would increase unwanted side effects. This is what emerges from the results of a Dutch study presented in recent days in Milan during the European Breast Cancer Conference.

«Boost»: the standard additional dose

Research Young boost trial involved 2,421 patients under 50 years old (average age of 45 years) treated in 32 centers in Holland, France and Germany. After surgery to remove the tumor and after radiotherapy to the entire breast, the patients were divided into two groups: one part received the so-called «boost», i.e. the standard additional dose of radiotherapy (16 Grays in 8 applications) and another underwent intensified dosing (26 Grays in 13 applications). Most patients were also treated with chemotherapy.
“Young patients with breast cancer generally have worse prognoses than older patients and are more likely to have a recurrence at the same site after conservative surgical treatment,” he explained. Sophie Bosma, radiotherapist at The Netherlands Cancer Center in Amsterdam and first author of the trial -. We wanted to understand if it was possible reduce the risk of local relapse by administering an additional high dose of radiation.”

The results of the research

The participants were monitored for approximately 12 years and during this period 109 had a recurrence in the same breast: 61 (equivalent to a ten-year local recurrence rate of 4.4%) had received the usual boost dosage of radiotherapy, 48 had instead undergone the intensified dosage (the 2nd, 8%).
However, 48% of patients treated with high doses also faced one severe or moderate breast fibrosis, compared to 27% of women treated with the standard. «Radiation therapy to the breast can cause hardening of the irradiated tissue – he clarifies Icro Meattini, associate professor of Radiotherapy and director of the Breast Unit of the Careggi University Hospital of Florence -: fibrosis is caused by an accumulation of scar tissue and can be very annoying, as well as having an aesthetic impact.”
«In both groups i Local recurrence rates were very low, better than we expected, and the difference is minimal, so the risk of side effects such as fibrosis must be carefully weighed – commented Bosma -. The benefit obtained with a high dose of radiation does not justify the negative aesthetic consequences that may result.”

Radiotherapy for 7 out of 10 cancer patients

Today a radiotherapy treatment comes prescribed to approximately 70% of cancer patientsfor many different types of cancer, alone or associated with other treatments (surgery, chemotherapy, hormone therapy, immunotherapy) and to achieve different objectives (from complete healing to pain control).
Radiotherapy sessions they are a cornerstone in the treatment of breast cancer due to their undoubted usefulness in reduce the risk of both local recurrences (post-surgery radiation helps to “clean up” the area better affected by the tumor) and distant metastasis. In the face of undoubted advantages for patients, however, specialists always also weigh the possible disadvantages in terms of side effects (mostly pain and the appearance of lymphedema, the annoying swelling in the arm).
“THEntensifying therapy is not always the right answer. The current standard in young women diagnosed with breast cancer in the early stages, given the results of this study, is confirmed as the optimal strategy” concludes Meattini.