The updated guideline on the diagnosis and management of early and locally advanced breast cancer published today by NICE (14 June 2023) recognises the positive impact that shorter intensity and duration of radiotherapy for some people with invasive breast cancer after they’ve had surgery has had on services and patients.
Until recently it was standard practice for people with invasive breast cancer having surgery to have 15 radiotherapy treatments (or ‘fractions’) giving a total of 40 units of radiation (measured in Gray, (Gy)) over 3 weeks.
During the COVID-19 pandemic NICE said the NHS should consider alternative radiotherapy schedules to reduce the risk to vulnerable cancer patients of catching COVID and to reduce pressure on hospitals.
For its updated guideline NICE looked at new clinical trial evidence that did not show any 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, and the committee agreed that the shorter intensity regimen was safe.
The updated guideline now recommends that people should be offered 26 Gy in 5 fractions over 1 week as part of routine practice.
The guideline also says people can still be offered a higher dose and intensity of radiotherapy if they have a diagnosis that increases sensitivity to radiotherapy, or have had implant–based reconstruction, or have any other factor (such as a high BMI) that could mean having radiotherapy over 3 weeks is more acceptable.
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.
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 1 week, rather than over 3 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.”
