Northwell team beats hypofractionation’s drum

Not-so-new weapon: Hypofractionation radiation therapy, which delivers more intense radiation doses over shorter periods of time, hasn't generally been prescribed in breast-cancer cases ... but that may change soon, thanks in part to a team of Northwell Health scientists.

From the You Don’t Have to Cut to Cure file comes new research suggesting that a specific form of radiation therapy, previously thought to be ineffective against breast cancer, might in fact be a winning strategy against the dreaded disease.

Researchers from Northwell Health’s Department of Radiation Medicine, part of the New Hyde Park-based health system’s multifaceted Cancer Center, and the Feinstein Institute for Medical Research, Northwell’s R&D mothership, are adding their voice to the chorus singing the praises of hypofractionation radiation therapy – a treatment protocol that, until now, has been largely overlooked as a potential weapon in the war against breast cancer.

Representing the cutting-edge of non-cutting cancer treatments, hypofractionation radiation therapy involves more intense radiation doses administered over shorter timeframes, ostensibly lowering toxicity levels.

More commonly used to battle other forms of cancer (prostate cancer, for instance), particularly abroad, hypofractionation radiation therapy – also known as stereotactic hypofractionated accelerated radiation therapy – is not new. The American Society for Radiation Oncology adopted clinical guidelines on the use of hypofractionation back in 2011.

And the Northwell Health team is not the first to suggest its application in breast cancer cases – research dating back over the past decade notes hypofractionation radiation therapy’s potential breast-cancer benefits, particularly after lumpectomy procedures.

But the findings of the Northwell Health researchers, recently published in the open-access medical journal Advances in Radiation Oncology, demonstrate that a majority of breast-cancer patients – “most” breast-cancer patients, according to the health system – can be treated with hypofractionation radiation therapy.

The Long Island-based investigators cite “randomized clinic trials” they say prove the therapy is “comparable” to other radiation therapies insofar as effectiveness against breast cancer, while delivering less of a toxic sting.

Lucille Nichols Lee: Hypofractionation radiation therapy is underused — so far.

The goal of the study – led by doctors Lucille Nichols Lee, Philip Gilbo and Louis Potters – was to determine if “implementing certain programs in the Radiation Medicine Department” could increase the adoption of hypofractionation radiation therapy as a breast-cancer treatment at Northwell Health.

The answer was a resounding “yes,” according to Lee, an assistant professor of Radiation Medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

By developing “consensus-based treatment directives” and reviewing cases with other Radiation Medicine Department faculty on a case-by-case basis, hypofractionation radiation therapy turned out to be the right call for more than 73 percent of female breast-cancer patients, Lee noted.

During the study, the researchers implemented what Northwell Health called “consensus-based, evidence-driven guidelines” to help medical professionals make treatment decisions. They also developed a “peer-reviewed case-review program,” through which the course of treatment for each patient was reviewed and a consensus opinion was reached.

When there was a disagreement about a treatment plan between the treating physician and the peer group, the treating physician was “expected to defend his or her choice and influence the group to change their mind” – and if they couldn’t, they were expected to “go with the consensus opinion,” according to Northwell Health.

The end result was that hypofractionation radiation therapy was proven the way to go in nearly three-quarters of reviewed cases – proof-positive, according to Lee, that the more-intense, shorter-duration radiation protocol “is underused in the treatment of breast cancer, despite equal control, less acute toxicity and similar side effects.”

Large-scale adoption of hypofractionation radiation therapy in breast-cancer cases is still a ways off – it takes “many years to develop a new treatment program,” Feinstein Institute President and CEO Kevin Tracey noted in a statement, “and then we face the challenge of the medical community adopting it into their practices” – but the efforts of the Northwell Health team could ultimately prove beneficial to a large percentage of breast-cancer patients.

“Being treated in three weeks instead of six … is something that many breast-cancer patients are looking for, as it means less disruption of their daily lives,” said Potters, a Feinstein Institute professor and chairman of the Department of Radiation Medicine. “By developing this program to increase adoption, we are both meeting the patient’s needs of reduced treatment time and less toxicity while also educating the medical community that the treatment regimen is an effective alternative.”


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