START-B (UK Standardisation of Breast Radiotherapy)
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.
Overview
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.
- 4.3 vs 5.5 out of 100 reached this endpoint at 10 years with 40 Gy in 15 fractions compared with 50 Gy in 25 fractions; 1.2 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: 40 Gy in 15 fractions over three weeks versus 50 Gy in 25 fractions over five 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.
2,215 participants 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% |
Similar pages
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