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Hypofractionation: lessons from complications.

G H Fletcher1

  • 1Department of Clinical Radiotherapy, University of Texas, M.D. Anderson Cancer Center, Houston 77030.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|January 1, 1991
PubMed
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Hypofractionation, using larger radiation doses per fraction, may lead to severe late side effects. Careful dose adjustment is crucial if hypofractionation is used for specific tumor types to avoid increased morbidity.

Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Hypofractionation, defined as fewer than 5 fractions per week with doses exceeding 2 Gy per fraction, emerged in the 1960s to reduce patient treatment burden and machine time.
  • Early studies, including those at UTMDACC for breast cancer in 1962, indicated comparable acute skin reactions but more severe late sequelae with 3-day-a-week treatments compared to 5-day treatments.

Purpose of the Study:

  • To review the historical use and outcomes of hypofractionation in radiation therapy.
  • To evaluate the evidence regarding the safety and efficacy of hypofractionation, particularly concerning late complications.

Main Methods:

  • Historical review of hypofractionation techniques and their evolution.
  • Analysis of clinical outcomes and reported complications from published literature.

Related Experiment Videos

  • Examination of dose-adjustment formulas like NSD, TDF, and CRE used to modify total radiation doses based on fractionation schedules.

    • Main Results:

    • While hypofractionation was introduced for convenience, historical data and numerous publications report a high incidence of severe complications.
    • Evidence suggests that fraction sizes exceeding 2 Gy are associated with unfavorable late sequelae.
    • The study highlights that hypofractionation should be avoided unless specific tumor characteristics warrant its use, necessitating careful dose correction.

    Conclusions:

    • Hypofractionation, especially with fraction sizes >2 Gy, is linked to increased late adverse effects.
    • The use of hypofractionation should be carefully considered and only employed when clinically indicated for specific tumor types.
    • When hypofractionation is used, total radiation doses must be adjusted to mitigate the risk of increased late morbidity.