FAST-Forward
FAST-Forward cut breast radiotherapy to five treatments in a single week and showed the same low relapse rate as the three-week standard, with similar late effects at five years.
Overview
FAST-Forward randomised 4,096 women with early breast cancer to 40 Gy in 15 fractions, 27 Gy in five or 26 Gy in five fractions over one week. Five-year ipsilateral breast tumour relapse was 2.1 percent after 40 Gy and 1.4 percent after 26 Gy, meeting the non-inferiority margin; late normal-tissue effects after 26 Gy were similar to the standard arm while 27 Gy gave more (Murray Brunt and colleagues, Lancet 2020). One-week radiotherapy became standard in the UK and, accelerated by the pandemic, widely elsewhere.
- 1.4 vs 2.1 out of 100 reached this endpoint at 5 years with 26 Gy in 5 fractions compared with 40 Gy in 15 fractions; 0.7 fewer per 100.
- On this measure the first group did worse, not better.
- This endpoint is not one of the standard survival or response measures; read it alongside the trial's primary result.
- These results apply to the people the trial enrolled: Early breast cancer after surgery: 26 Gy in five fractions over one week versus 40 Gy in 15 fractions over three weeks. People in a different situation may not see the same effect.
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.
4,096 participants enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Ipsilateral breast tumour relapse at 5 yearsprimary | 26 Gy in 5 fractions | 1,368 | 1.4% | - | - | - |
| 40 Gy in 15 fractions | 1,361 | 2.1% |
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