Hypofractionation in adjuvant breast radiotherapy

Altered fractionation for whole breast irradiation has been extensively studied over the past 20 years, with recent updated publications from several landmark randomized trials. In this review, the radiobiological principles underlying altered fractionation schedules are reviewed, and outcomes, including local control, acute and chronic toxicities from the major published studies are summarized. While the studies published to date provide strong clinical evidence demonstrating acceptable results with hypofractionated regimens, there remain many unanswered questions. The current status of hypofractionated radiation and future directions for research are discussed.