Hypofractionated Postoperative Radiation Therapy for Breast Cancer – Do We Need More Evidence or Adapted Reimbursement Policies?

Abstract

More than 10 years ago, two pivotal trials, the Ontario Clinical Oncology Group trial\nand START B trial, firmly established that hypofractionated radiation therapy (RT) of\n40–42.5 Gy in 15–16 fractions over 3 weeks after breast conserving surgery or\nmastectomy results in similar rates of local recurrence and normal tissue effects. This\nled to a new standard for postoperative whole breast and chest wall RT. Further trials\nconfirmed these findings and show that hypofractionated RT can also be applied for\nother indications, including regional nodal RT and for ductal carcinoma in situ (DCIS).\nMore recently, a so-called ultra-fractionation trial demonstrated that 26 Gy in 5\nfractions over 1 week was non-inferior to 40 Gy, in 15 fractions in 3 weeks for local\nrecurrence at 6 years and that late effects were similar between fractionation\nschedules being a treatment option for most patients with early breast cancer. Several\ncountries and departments are now adopting hypofractionated schedules as a new\nstandard for breast, chest wall or partial breast RT. In addition to the improvement in\nconvenience and reduction in resources required, hypofractionated RT offers important\nbenefits with respect to acute and late toxicity that can improve the quality of life of\npatients receiving breast RT.