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Lower intensity, shorter duration radiotherapy safe and effective for some breast cancer, says NICE

Delivering fewer radiotherapy sessions of lower intensity over a shorter period of time after surgery for some people with invasive breast cancer has a positive impact on patients and the NHS, according to new guidance from NICE.

This alternative radiotherapy schedule was first introduced during the Covid-19 pandemic to reduce transmission of the virus to vulnerable patients and reduce pressure on radiotherapy departments and hospitals. It formed the foundation of a clinical trial reviewed by NICE as part of its updated guideline on the diagnosis and management of early and locally advanced breast cancer, published on 14 June 2023.

The trial showed no difference in terms of breast cancer-related mortality or disease recurrence between a higher dose and longer intensity of radiotherapy treatment and a lower dose shorter intensity of radiotherapy treatment. The NICE committee agreed that the shorter intensity regimen was safe.

Until recently, standard practice for people with invasive breast cancer having surgery was to have 15 radiotherapy fractions giving a total of 40 units of radiation (Gy) over three weeks.

The updated guideline now recommends that they should be offered 26 Gy in five fractions over one week as part of routine practice.

‘Already reaping rewards’

Commenting on the widespread benefits of the new guidance, Jonathan Benger, NICE’s chief medical officer, said: ‘Lower intensity, shorter duration radiotherapy in response to pandemic pressures and NICE’s rapid Covid-19 guidelines for some people with invasive breast cancer is now embedded in practice and already reaping rewards.

‘And apart from enabling the NHS to make efficiencies, save money and free up services, it’s likely most people will prefer to attend radiotherapy appointments over the course of one week, rather than over three weeks for practical reasons related to fewer trips to the hospital – for example, reduced travelling time and costs, less time off work or from caring responsibilities.’

Around 26,700 people have radiotherapy for early and locally advanced breast cancer each year in England. Shorter intensity and duration of radiotherapy means that for every 1,000 people receiving the lower number of fractions, 10,000 NHS radiotherapy appointments have been freed up in England every year, reducing pressure on services and allowing the NHS to see more people.