19 Fractionation sensitivity of breast cancer. Results of a randomised trial

Owen, John R.; Ashton, Anita; Regan, John-Paul; Broad, B.; Jackson, Cynthia M.; Homewood, J.; Bliss, Judith M.; Bentzen, S.M.; Yarnold, John

doi:10.1016/s1359-6349(03)90053-x

Cited by 8 publications

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“…For this reason, full publication of the current tumour control data has not yet been authorised by the START Trial Steering Committee. However, the tumour control data have been presented in a published abstract, which generate an a/b value for ipsilateral local tumour control of 4.1 Gy (95% CI 1.0-9.7) [12]. The wide confidence intervals reflect the relatively small number of tumour-related events, but the point estimate is entirely consistent with the hypothesis under test in the trial.…”

Section: Discussionmentioning

confidence: 81%

“…The START trial of 4451 patients includes a similar randomisation with tumour control as the primary endpoint and patient self-assessments of functional outcome and quality of life as important secondary endpoints. The independent START Trial Steering Committee has authorised the full publication of the late radiotherapy normal tissue effects of the pilot trial, the subject of this manuscript [12,21].…”

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confidence: 99%

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Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial

Yarnold

Ashton²,

Bliss

et al. 2005

Radiotherapy and Oncology

460

306

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Background and purpose: Unlike squamous carcinomas, breast adenocarcinoma may be as sensitive to fraction size as late dose-limiting normal tissues. If so, fewer larger fractions would be as safe and effective as regimens based on 2.0 Gy fractions. The first step is to test the effects of radiotherapy fractions O2.0 Gy on late normal tissue responses in the breast after tumour excision and radiotherapy for early breast cancer.Patients and methods: One thousand four-hundred and ten women with T1-3 N0-1 M0 invasive breast cancer were randomised between 1986-98 into one of three radiotherapy regimens after local tumour excision of early stage breast cancer; 50 Gy in 25 fractions (F) vs two dose levels of a test schedule giving 39 or 42.9 Gy in 13 F over 5 weeks. Fraction sizes were 2.0, 3.0 and 3.3 Gy, respectively. The primary endpoint was late change in breast appearance compared to post-surgical appearance scored from annual photographs blinded to treatment allocation. Secondary endpoints included palpable breast induration (fibrosis) and ipsilateral tumour recurrence.Results: After a minimum 5-year follow up, the risk of scoring any change in breast appearance after 50 Gy/25 F, 39 Gy/13 F and 42.9 Gy/13 F was 39.6, 30.3 and 45.7%, from which an a/b value of 3.6 Gy (95% CI 1.8-5.4) is estimated. The a/b value for palpable breast induration was 3.1 Gy (95% CI 1.8-4.4).Conclusions: An a/b value of around 3 Gy for late normal tissue changes in the breast is derived from the estimated equivalence of 41.6 Gy in 13 fractions and 50 Gy in 25 fractions over 5 weeks, in line with trial predictions. q 2005 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 75 (2005) 9-17.

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confidence: 81%

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confidence: 99%