Three-week radiation course a safe option for breast cancer patients undergoing reconstruction, trial shows

by Alliance for Clinical Trials in Oncology

edited by Lisa Lock, reviewed by Andrew Zinin

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Results of a national clinical trial led by the Alliance for Clinical Trials in Oncology in conjunction with NRG Oncology and the Canadian Cancer Trials Group show that a shorter, three-week radiation schedule following a mastectomy is as safe and effective as the standard five-week treatment for women undergoing breast reconstruction. The results of the RT CHARM trial (Alliance A221505) are published in the Journal of Clinical Oncology.

For years, doctors have used a shorter radiation approach, known as hypofractionated radiation therapy, for women who have a lumpectomy, surgery that removes the cancerous tumor while preserving the breast. This schedule delivers slightly higher daily doses of radiation per treatment over fewer total visits, reducing the treatment time by nearly half.

However, the use of this shorter approach after mastectomy, which removes the entire breast, has been more limited for women who choose breast reconstruction. Clinicians have been concerned that higher daily radiation doses could increase complications and affect the success of the reconstruction.

"Patients undergoing mastectomy and reconstruction already face a challenging medical journey. Having the evidence to allow women to confidently shorten their radiation treatment from five weeks down to three will save patients time, reduce their financial stress and let them get back to their daily lives sooner—all without increasing complications, lowering their chances of cure or sacrificing cosmetic results," said Matthew M. Poppe, M.D., lead author of the study, a radiation oncologist at the Huntsman Cancer Institute at the University of Utah and vice chair of the Alliance Breast Committee. "These results give us the data to safely change practice."

Key results of the RT CHARM trial

The trial evaluated 828 patients at 209 academic and community medical centers across the United States and Canada. Half of the patients received standard radiation (25 treatments over five to six weeks), while the other half received the shorter radiation schedule (16 treatments over three to four weeks).

• Comparable reconstruction safety: Two years after treatment, surgical complication rates were similar—12.3% for those receiving the shorter schedule and 10.2% for those receiving the standard schedule. Statistical analysis confirmed the shorter course was noninferior to standard therapy regarding reconstruction complications.
• Comparable cancer control: After nearly four years of follow-up, cancer recurrence rates in the treated area remained low for both groups: 1.5% for the shorter schedule versus 2.2% for the standard schedule.
• Applicable to different reconstruction approaches: The trial included patients receiving implant-based reconstructions as well as those receiving autologous reconstruction, which uses the patient's own tissue (called flaps). The findings support the shorter radiation schedule for both reconstruction types.

"RT CHARM provides the clearest picture to date on how shorter radiation therapy schedules interact with modern breast reconstruction techniques," added Poppe. "It gives radiation oncologists, breast surgeons and plastic surgeons the reliable information they need to help patients make the most informed choices for their care."

Publication details

Matthew M. Poppe et al., Randomized Trial of Hypofractionated Postmastectomy Radiation Therapy in Women With Breast Reconstruction (RT CHARM, Alliance A221505), Journal of Clinical Oncology (2026). DOI: 10.1200/jco-26-00474

Journal information: Journal of Clinical Oncology

Key medical concepts

Breast ReconstructionBreast CancerSurgical Complicationcancer recurrence

Clinical categories

OncologyWomen's healthGeneral surgery Provided by Alliance for Clinical Trials in Oncology Who's behind this story?

Lisa Lock

BA art history, MA material culture. Former museum editor, paramedic, and transplant coordinator. Editing for Science X since 2021. Full profile →

Andrew Zinin

Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →

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