Optimising radiotherapy to improve early-stage breast cancer patient outcomes

Project Description:

Radiotherapy is considered an essential part of breast conserving treatment for early breast cancer, aiming to reduce the risk of the cancer returning in the same breast. However, radiotherapy can cause considerable short and longer-term side-effects. In a previous clinical study, the PROSPECT trial, partly funded by NBCF, Prof Bruce Mann and colleagues used Magnetic Resonance Imaging (MRI) and pathological features of the tumour to identify a significant number of patients with early-stage breast cancer for whom radiotherapy could be safely omitted. This new NBCF-funded study, the PROSPECTIVE trial, aims to gather comprehensive data in a large multicentre international trial to validate the results from the PROSPECT trial.

Why is this work needed:

Breast cancer ranks as the second most frequently detected cancer in Australia with over 20,000 cases diagnosed annually. About 75% (15,000) are patients over the age of 50 and 30% (4,500) of them will present with early-stage breast cancer. Radiotherapy plays a critical role in the management of these patients but can cause considerable short and long-term side-effects. Hence, identification of a group of patients in whom radiotherapy can be safely omitted is a long-term aim of breast cancer research.

Expected outcomes:

Successful outcomes of the PROSPECTIVE clinical trial will validate the findings of PROSPECT using MRI and pathology findings to identify patients that can safely avoid radiotherapy. By omitting radiotherapy, it will reduce the side effects and costs of treatment. Positive results from the PROSPECTIVE trial, could lead to over 2,000 Australians annually avoiding radiotherapy for early stage breast cancer.

Project description:

Breast cancer is second most frequently detected cancer in Australia with over 20,000 diagnosed annually and the most common cancer among women. About 75% (15,000) are patients over the age of 50 and 30% (4,500) of them will present with early-stage breast cancers. The standard-of-care treatment for these women is breast conserving surgery followed by radiotherapy and treatments to minimise the risk of other recurrences. Radiation therapy is seen as an essential part of breast cancer treatment to minimise the chance of the cancer returning in the same breast. However, it can have considerable short and longer-term side effects.

The proof-of-concept clinical trial PROSPECT, conducted by Prof Bruce Mann and colleagues was designed to examine whether a combination of preoperative magnetic resonance imaging (MRI) and pathological features of the tumour could identify women with early-stage breast cancer who could safely avoid radiotherapy.

The trial screened 443 Australian patients and radiotherapy was omitted in 201 of these patients. After a 5-year follow-up cancer returned in the original site in only 1% of the patients who did not receive radiotherapy, and the rate of other recurrences was very low. Specifically there were no distant recurrences from the original cancer after a median of 5 years follow up

With NBCF support Prof Bruce Mann and colleagues aim to conduct the PROSPECTIVE clinical trial which will recruit a larger international cohort of patients to validate the findings of the PROSPECT trial.

With the incidence of breast cancer steadily increasing over time and continuing to outpace Australia’s population growth there is a need to investigate methods for improving the management of early-stage, low risk breast cancer. This could involve identifying individuals who may benefit from standard treatments and those for whom radiotherapy can be safely omitted.