A trial looking at the standardisation of breast radiotherapy (START A)

This trial looked at different ways of giving radiotherapy after surgery for early stage breast cancer.

Many women have radiotherapy after surgery for early stage breast cancer. This is to reduce the risk of the cancer coming back. There are different ways of having radiotherapy, called schedules. A schedule means the number of doses you have and how big each dose is. A radiotherapy dose is called a fraction and is measured in units called ‘grays’.

This trial compared 3 different schedules for women who have had surgery to remove early stage breast cancer. The aim of the trial was to find out which one

Is best at stopping breast cancer coming back after surgery
Causes the fewest side effects

There are 2 START trials – START A and START B. This information is about START A. There is information about START B on a separate entry in the trials database.

Recruitment

Start 01/08/1999

End 01/05/2002

Phase

Phase 3

Summary of results

The research team found that having fewer, larger doses, but a lower total dose of radiotherapy, is as safe and works as well as the standard higher dose for women with early stage breast cancer.

The trial recruited 2,236 women into one of 3 groups. There were about 750 in each group. All the women taking part had radiotherapy over 5 weeks.

Group 1 had radiotherapy 5 times a week, with a total dose of 50 gray in 25 doses of 2 gray
Group 2 had radiotherapy 5 times a fortnight, with a total dose of 41.6 gray in 13 doses of 3.2 gray
Group 3 had radiotherapy 5 times a fortnight, with a total dose of 39 gray in 13 doses of 3 gray

After an average follow up of just over 5 years, the number of women whose cancer came back in the breast was low (between 3.5% and 5.2%) in all 3 groups.

The research team also looked at the effects of the different radiotherapy schedules on normal breast tissue. Nearly half the women taking part had photographs of their breast taken before radiotherapy, and again after treatment. Just under a third of these women had changes in the appearance of their breast, but most of the changes were described as mild. This did not vary much between the groups, but the women in group 3 had slightly fewer changes than women in the other groups.

The trial team will continue to follow up the women in this trial and will do another analysis in the future, looking at the long term effects.

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