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START-B showed that three weeks of breast radiotherapy in larger daily doses controls the cancer as well as five weeks of smaller ones, with fewer late changes to the breast, and made 40 Gy in 15 fractions the UK standard.
START-B randomised 2,215 women with early breast cancer to 40 Gy in 15 fractions or the international standard of 50 Gy in 25. At ten years, local-regional relapse was 4.3 percent with the shorter schedule and 5.5 percent with the standard one, and moderate or marked late normal-tissue effects were less frequent after 40 Gy (Haviland and colleagues, Lancet Oncology 2013, following the 2008 Lancet report). Together with START-A it established that breast cancer is as sensitive to fraction size as normal tissue, the radiobiological basis for hypofractionation.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
2,215 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Local-regional relapse at 10 yearsprimary | 40 Gy in 15 fractions | 1,110 | 4.3% | - | - | - |
| 50 Gy in 25 fractions | 1,105 | 5.5% |
Shares FAST (5-fraction whole-breast radiotherapy), START-A (UK Standardisation of Breast Radiotherapy, trial A), Partial-breast irradiation, Hypofractionation (fewer, larger radiotherapy doses) and the tag radiation-wave2.
Shares Partial-breast irradiation, Hypofractionated radiotherapy, The Institute of Cancer Research, HER2-positive breast cancer and the tag radiation-wave2.
Shares Partial-breast irradiation, HER2-positive breast cancer, Breast cancer (all types), IMRT / IGRT (modern external beam) and the tag radiation-wave2.
Shares Alpha/beta ratio, Hypofractionation (fewer, larger radiotherapy doses), Hypofractionated radiotherapy, The Institute of Cancer Research and the tag radiation-wave2.
Shares Breast cancer (all types), IMRT / IGRT (modern external beam), HR-positive / HER2-negative breast cancer and the tag radiation-wave2.
Shares Breast cancer (all types), IMRT / IGRT (modern external beam), HR-positive / HER2-negative breast cancer and the tag radiation-wave2.
Shares Hypofractionated radiotherapy, The Institute of Cancer Research and the tag radiation-wave2.
Shares Breast cancer (all types), HR-positive / HER2-negative breast cancer and the tag radiation-wave2.