Delivering radiotherapy in 5 days instead of 3 to 5 weeks - this is the new challenge taken up by Gustave Roussy. The Institute now offers women over 60, with localised breast cancer, fewer but equally effective radiotherapy sessions after surgery. This constitutes a first in terms of care and organisation, and was introduced following recommendations from learned radiotherapy societies on how to tackle cancer more effectively in the light of the Covid-19 pandemic.
This care pathway is based on new technologies (artificial intelligence, scripted dosimetry, image-guided radiotherapy and controlled breathing) which reduce session preparation time on the one hand and the number of sessions required on the other hand, using hypofractionated and personalised radiotherapy.
Post-surgical radiotherapy is one of the treatment pillars for localised breast cancer following lumpectomy - a conservative surgical technique. It complements surgery by destroying any remaining cancer cells in an attempt to minimise the risk of local recurrence and to boost recovery rates. It is beneficial in the event of disease recurrence and also in terms of survival.
For women whose cancer does not involve lymph nodes, one session of hypofractionated radiotherapy per day for five days is as beneficial as 15 standard sessions over 3 weeks or 25 sessions over 5 weeks, but without any significant additional side effects.
Based on several English studies and recommendations from learned societies, Gustave Roussy has developed this new and compact radiotherapy pathway for patients with localised breast cancer without lymph node involvement. In fact, this accounts for over 50% of all breast cancers in France. “Thanks to this new programme, a full course of radiotherapy can be delivered in one week, from the initial radiotherapy consultation to the end-of-treatment consultation on the fifth day," explains Dr Sofia Rivera, Head of the Breast Radiotherapy Department at Gustave Roussy.
New technologies and a more efficient validation process allow all of the pre-session preparatory work to be compacted into a few hours as opposed to the standard 7 to 15 days generally required. This preparation begins with a radiotherapy consultation followed by a simulation scan in preparation for radiotherapy and to define treatment volumes. "The scan is performed in the treatment position and normally in deep-inspiration breath hold to position the breasts away from the heart and lungs that we want to protect," says Dr Rivera.
The next step involves preparing the treatment plan per se, based on the CT images. The patient will undergo her first personalised, high-precision, image-guided radiotherapy session with synchronised breathing later that same day (during the afternoon). She will then return for one session per day over the next four days. The patient’s position is checked by the operators using guided imaging techniques before each session.
"This is a real team effort where every link in the chain counts and where everyone's expertise is needed from a technical, logistic and personal perspective to prepare the treatment plan, explain these practical changes to patients and support them on this journey," concludes Dr Rivera.
In 2020, the radiotherapy department treated 950 breast cancer patients.