Extreme weekly hypofractionation in breast cancer in elderly

Breast cancer is the second cause of cancer death worldwide. One-half of new cases are diagnosed in elderly patients, with a growing global life expectancy and with age being a major risk factor for breast cancer. Radiation therapy is one of the main treatments as adjuvant treatment whenever possible and as definitive if not. Daily conventional fractionation over 5 weeks is costly and lengthy, and alternatively weekly hypofractionation could be a good option in elderly patients with comorbidities, social problems and who live far from the treatment center. The purpose of this article is to review weekly hypofractionated schedules in elderly patients published in literature, in terms of locoregional recurrence (LRR) and side effects. There are eleven studies on the topic with different treatment schedules, 87.1% of lesions were adjuvant treatments and 12.9% definitive treatments, with a range of LRRs between 0% and 16% depending on several factors. The number of acute side effects as grade 3 or grade 4 was very low, being less than 15% in all series. The most significant late side effect was fibrosis in a range between 15.1% and 39.2%. Extreme weekly hypofractionated radiation therapy seems to be a safe treatment without significant side effects.