In recent years, radiation oncology has seen remarkable progress in making cancer treatment more precise, efficient, and patient-centered. One of the most meaningful advances for breast cancer patients is the move toward shorter-course radiation therapy, reducing the number of treatments without compromising outcomes.

Hunter Boggs, M.D., associate professor in the Department of Radiation Oncology, discusses how advances in technology and treatment planning have made shorter-course radiation a safe, effective, and patient-centered option for breast cancer care.

General context and innovation

Can you explain what “shorter-course radiation” means in the context of breast cancer treatment?
Boggs: Traditionally, breast cancer was treated over a course of five to six weeks. This was due to concern that treating with a higher dose each day would increase the chance of side effects such as scarring and breast pain. Over the past few decades, many studies have shown that it is safe to reduce the overall number of treatments by increasing the dose per day. These studies have demonstrated that, for appropriate patients, side effects are similar to more prolonged treatments, and cure rates are identical.

What advances in radiation oncology have made it possible to safely shorten treatment schedules for breast cancer patients?
Boggs: In the modern era, we are able to use more sophisticated techniques to ensure an even distribution of radiation dose into the areas that need to be treated. We also have more tools to reduce exposure to critical organs near the radiation field, such as the heart and lungs. One such technology is called deep inspiration breath hold treatment. This allows the patient’s lungs to expand and naturally pull the heart away from the treated field.

How does the Department of Radiation Oncology stay on the forefront of these innovations?
Boggs: Our department utilizes a technology called adaptive therapy. This treatment allows us to look at the patient’s anatomy on a daily basis, and if there are large changes, we can modify the treatment plan to create a more customized and personalized approach. We use this extensively for patients receiving partial breast irradiation.

Patient impact and quality of life

How do shorter treatment courses affect patients’ day-to-day lives compared to traditional schedules?
Boggs: Cancer treatment is disruptive. Patients often have to travel long distances to receive treatment and take time away from family and other responsibilities to get the care they need. By shortening treatment, patients are able to spend less time with us and more time where they need to be.

What kind of feedback have you received from patients who have undergone shorter-course treatment?
Boggs: Typically, patients are surprised when I tell them they can complete treatment in just five sessions versus a longer course. There is usually a sense of relief and excitement. Many patients express an attitude of, “I can do this,” when they learn the treatment is shorter than expected.

Are there specific examples of how shorter treatment courses have improved patient quality of life?
Boggs: One common example is with patients who have transportation difficulties. Some patients rely on someone to drive them long distances for radiation treatments. When they hear that they only need transportation for five treatments, it’s much easier to arrange and significantly reduces the burden of care.

Clinical outcomes and safety

How do outcomes for shorter-course radiation compare with traditional, longer treatment schedules?
Boggs: For patients requiring whole-breast radiation treatment, 15 to 16 treatments have been the standard for many years. More recently, studies have shown that five treatments to the whole breast are safe in many patients. For those requiring radiation treatment to regional lymph nodes for more advanced cancers, research has shown that a 15- to 16-treatment course provides the same outcomes as a longer regimen. New guidelines published by the American Society for Radiation Oncology and the Society of Surgical Oncology reaffirm these recommendations.

What safeguards are in place to ensure that patient safety and cancer control are not compromised by shorter treatment?
Boggs: We carefully assess clinical trials and review factors such as the length of follow-up and study design. Our department discusses these findings collectively, often in journal clubs, before deciding to change practice. We closely follow national guidelines as well. If there is any concern, such as in patients with autoimmune diseases like scleroderma, we may choose to treat over a longer period.

Are there certain patient populations or cancer stages for which shorter-course treatment is especially beneficial?
Boggs: Sick and elderly patients primarily benefit from shortened courses of radiation treatment. Breast cancer is more common in older populations, and transportation challenges or the discomfort of lying on a treatment table can be significant. Reducing the overall number of treatments helps make therapy more tolerable and accessible for these patients.

Looking ahead

What ongoing research is your department involved in that might further improve efficiency and outcomes for breast cancer treatment?
Boggs: We currently have a clinical study open that is evaluating more precise setup margins for breast cancer patients undergoing partial breast irradiation using adaptive treatment. This is a five-day course. Future studies are assessing even shorter regimens—potentially three or even one treatment for partial breast irradiation.

What advice would you give to patients considering radiation therapy about discussing treatment length and options with their care team?
Boggs: If your physician recommends a prolonged course such as five-and-a-half to six weeks, ask if there is potential to safely treat over a shorter period. There may be a valid reason for a longer course, but it is always worth discussing with your oncology provider.

Through research, technology, and a patient-first philosophy, Boggs and the Department of Radiation Oncology are helping make breast cancer treatment more efficient, comfortable, and effective. By embracing shorter-course radiation and adaptive therapy, they’re not only improving outcomes but also giving patients more time to focus on what matters most: living their lives.