A trial looking at giving 1 week of radiotherapy for breast cancer (FAST-Forward)

Cancer type:

Breast cancer

Status:

Results

Phase:

Phase 3

This trial compared 1 week of radiotherapy with 3 weeks of radiotherapy after surgery for breast cancer.

This trial was open for people to join between 2011 and 2014. The team published the results in 2020.

More about this trial

It is usual to have surgery followed by radiotherapy for early breast cancer. Early breast cancer means the cancer hasn't spread beyond the breast or the lymph nodes Open a glossary item in the armpit on the same side of the body. 

When this trial was done, it was standard to have 15 radiotherapy treatments over 3 weeks. Doctors knew from research that it might be possible to give a lower total dose of radiotherapy. And that they could give this in fewer, larger daily doses. 

Some people in the trial had standard radiotherapy for 3 weeks. Each treatment is called a fraction. They had 15 treatments. And some had it for 1 week. They had 5 treatments.

The main aims of the trial were to find out:

  • if giving 1 week of radiotherapy works as well as 3 weeks of radiotherapy
  • how safe it is to have the 1 week schedule
  • what the long term side effects are

Summary of results

The trial team found that having 5 doses of radiotherapy over 1 week worked as well as having 15 doses over 3 weeks. The team also found that having it over 1 week didn’t increase the long term side effects. 

Trial design
This was a phase 3 trial

There were 3 treatment groups:

  • Group 1 had 15 treatments (fractions) of radiotherapy over 3 weeks
  • Group 2 had 5 treatments of radiotherapy over 1 week
  • Group 3 also had 5 treatments of radiotherapy over 1 week. Their dose was a little bit lower than in Group 2. 

Everyone had radiotherapy every day (Monday to Friday).

4,096 people took part in this trial. A computer put them into a treatment group at random. Radiotherapy is measured in units called Gray (Gy). There were:

  • 1,361 people in group 1. They had a total of 40 Gy in 15 treatments.
  • 1,367 people in group 2. They had a total of 27 Gy in 5 treatments.
  • 1,368 people in group 3. They had a total of 26 Gy in 5 treatments.

After radiotherapy everyone had a check up with their doctor once a year. 

Results
The team followed everyone up for about 5 years. They looked at whose cancer came back in the treated breast. They found this was low in all 3 groups. It happened in:

  • 31 people in group 1 (2.3%)
  • 27 people in group 2 (2.0%)
  • 21 people in group 3 (1.5%)

The researchers also looked at:

  • whose cancer came back in the treated breast or in nearby lymph nodes Open a glossary item
  • whose cancer came back in another part of the body
  • the time between treatment aimed at curing cancer, and signs that it had come back
  • how long people lived after treatment

They found no difference in any of these between the 3 treatment groups.

Side effects
The research team looked at the long term side effects of radiotherapy for each group. These were assessed by trial doctors and patients themselves. 

It is common to have some long term side effects from radiotherapy to the breast tissue or chest wall. For all 3 groups these included: 

  • breast shrinkage
  • changes to the appearance of the breast 
  • thickening of the breast tissue
  • swelling to the breast or chest wall

12 months after radiotherapy finished and for up to 5 years, the trial doctors graded these long term side effects. They were mainly interested in those that were moderate or noticeable. They found that at 5 years at least one of these side effects had happened in:

  • 98 out of 986 people in group 1 (9.9%)
  • 155 out of 1,005 in group 2 (15.4%)
  • 121 out of 1,020 in group 3 (11.9%)

Breast shrinkage was the most common breast tissue side effect.  

Those who had 27Gy of radiotherapy had an increased risk of moderate or noticeable breast tissue side effects. People in the other two groups had similar side effects though these were low in all groups.

During the trial just under half of the patients filled in questionnaires. These reported side effects such as changes in the shape, size, and feel of the breast. At 5 years a change in breast appearance was the most commonly reported side effect for all 3 groups. Patient reported breast tissue side effects were similar for the people who had 26Gy compared to those who had 40Gy.

Photographs
Some people had photographs taken to check for changes in breast appearance. These were done before radiotherapy and at 2 and 5 years afterwards. Those who had 27Gy had an increased risk of mild or noticeable changes in breast appearance compared with those who had 40Gy. There was no difference between the group who had 40Gy and those who had 26Gy.

Conclusion
The trial team concluded that having 26Gy of radiotherapy over 1 week worked as well as having 40Gy over 3 weeks. This was in terms of the cancer coming back and the side effects. 

The trial team recommend that the 26Gy one week schedule should be the new standard of care for people with early breast cancer. 

Where this information comes from
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Professor Murray Brunt

Supported by

Experimental Cancer Medicine Centre (ECMC)
Institute of Cancer Research (ICR)
NIHR Clinical Research Network: Cancer
NIHR Health Technology Assessment (HTA) programme

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

Last review date

CRUK internal database number:

4556

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Harriet wanted to try new treatments

Picture of Harriet

“I was keen to go on a clinical trial. I wanted to try new cancer treatments and hopefully help future generations.”

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