Dr. Yarnold on Hypofractionation in the START Trials
John Yarnold, MBBS
Published Online: Friday, December 7, 2012
John Yarnold, MBBS, professor of clinical oncology at The Institute of Cancer Research in London and honorary consultant at The Royal Marsden NHS Foundation Trust, discusses results from the START A and B trials that examined hypofractionated radioatherapy for women with early breast cancer.
The START trials enrolled a total of 4451 women with completely excised invasive breast cancer. In START A, approximately 2236 patients received either 50 Gy in 25 fractions for five weeks compared to 41.6 Gy or 39 Gy in 13 fractions for five weeks. In the START B trial, 2215 patients were randomized to receive either 50 Gy in 25 fractions for five weeks or 40 Gy in 15 fractions for 3 weeks.
In the START B trial, administering 40 Gy over 3 weeks produced fewer adverse events and was noninferior at tumor control compared to 50 Gy for 5 weeks.
Yarnold notes that 40 Gy for 3 weeks in 15 fractions has been the current standard treatment option in the United Kingdom, since 2009. This approach has proven to be approximately 20% less harmful to patients while producing similar tumor control to 50 Gy for 5 weeks, which is the standard in the United States.
In the last decade, there have been tremendous improvements in the treatment of HER2-positive breast cancer with new HER2-targeted agents improving survival in both the adjuvant and metastatic settings.