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Hypofractionation: The standard for external beam breast irradiation
Adrian Murray Brunt1, Joanne Susan Haviland2
1David Weatherall Building, School of Medicine, University of Keele, Keele, Staffordshire, ST5 5BG, UK; Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, Sutton, London, UK.
Breast (Edinburgh, Scotland)
|April 30, 2023
Summary
External beam breast hypofractionation has evolved over 50 years. Current evidence supports 3-week radiotherapy, with 1-week regimens becoming standard for many patients, reducing treatment burden and costs.
Area of Science:
- Oncology
- Radiotherapy
- Medical History
Background:
- Early adoption of breast hypofractionation in the 1970s-1980s led to patient harm due to lack of clinical trials and quality assurance.
- A theoretical radiobiology model was used to justify hypofractionation for resource management, bypassing essential safety protocols.
Purpose of the Study:
- To provide a historical perspective on the evolution of external beam breast hypofractionation over the past 50 years.
- To review the evidence supporting moderate and ultra-hypofractionated radiotherapy regimens in breast cancer treatment.
- To identify current challenges and future research directions in breast hypofractionation.
Main Methods:
- Historical review of clinical practice and research in breast hypofractionation.
- Analysis of data from high-quality clinical trials comparing different fractionation schedules.
- Exploration of randomized trials investigating shorter radiotherapy durations.
Main Results:
- Initial hypofractionation attempts caused significant patient harm.
- High-quality trials demonstrate the efficacy of 3-week breast radiotherapy, with substantial evidence supporting its use.
- One-week radiotherapy is now standard for many breast cancer patients, offering reduced treatment burden and cost-effectiveness.
Conclusions:
- Despite historical setbacks, moderate hypofractionation (3-week) is well-supported by evidence for breast radiotherapy.
- Ultra-hypofractionation (1-week) is increasingly adopted as standard care, improving patient experience and healthcare economics.
- Further research is crucial to optimize 1-week schedules, especially regarding tumor bed boosts and post-reconstruction radiotherapy.
