Recommendations for hypofractionated whole-breast irradiation

Abstract

This recommendation consensus for hypofractionated whole-breast radiotherapy (RT) was organized by the Brazilian Society of Radiotherapy (SBRT) considering the optimal scenario for indication and safety in the technology applied. All controversies and contraindication matters (hypofractionated RT in patients who underwent chemotherapy [CT], hypofractionated RT in lymphatic drainage, hypofractionated RT after mastectomy with or without immediate reconstruction, boost during surgery, hypofractionated RT in patients under 50 years old, hypofractionated RT in large breasts, hypofractionated RT in histology of carcinoma in situ [DCIS]) was discussed during a meeting in person, and a consensus was reached when there was an agreement of at least 75% among panel members. The grade for recommendation was also suggested according to the level of scientific evidence available, qualified as weak, medium, or strong. Thus, this consensus will aid Brazilian radiotherapy experts regarding indications and particularities of this technique as a viable and safe alternative for the national reality.

Quality and reporting of clinical guidelines for breast cancer treatment: A systematic review

“…Of them, 168 publications were found duplicated and 7205 did not meet the selection criteria. A total of 59 documents (43 CPGs [ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] ] and 16 CSs 42–57 [ [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] ]) were identified for final evaluation ( Table 1 ). The flow diagram detailing the study selection process is provided in Fig.…”

“…In domain 5 (applicability) only 1 (2%) CPG scored >75%. Domain 6 (Editorial independence) related to the bias linked to conflict of interest, scored >75% in 34 (58%) CPGs but it was 0% or almost 0% in five CPGs [ 26 , 40 , 57 , 63 , 64 , 66 ] and four CSs [ 72 , 75 , 76 , 78 , 82 ]. The ASCO [ [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , 52 , 53 ], Dutch [ 31 ] and Colombian [ 58 ] CPGs had the highest quality scores ( Fig.…”

Adjuvant Hypo Fractionated Whole Breast Radiation therapy: A Review of Literature from Bench to Clinic

“…The local control was similar among different ages [9,15,24]. There was NO agreement regarding the safety of indication of hypofractionated RT of exclusively the breast for patients with age under 40 years [12].…”

“…The conventional fractionation (1.8-2 Gy per fraction) has been used as the standard over the last decades, with a total dose of 50-50.4 Gy over 25-28 sections, distributed over 5 consecutive weeks [12]. The use of small fractions (≤2•0 Gy) in curative radiotherapy is strongly based on reliable data for squamous carcinomas of the bronchus, cervix uteri, and head and neck ,which show that these tumors are much less sensitive than lateresponding healthy tissues to the size of individual fractions.…”

Hypofractionated radiotherapy in the real-world setting: An international ESTRO-GIRO survey

“…[1][2][3][4][5][6][7] In the curative setting of breast and prostate cancer, both among the most common cancers and often requiring radiotherapy 8,9 , a strong body of evidence supporting hypofractionation has informed professional society guidelines. [10][11][12] Within prostate cancer, three non-inferiority trials with over 30,000 combined patient-years of follow-up found that moderate hypofractionation was noninferior to conventionally fractionated treatment for 5-year biochemical or clinical failure. [5][6][7] In breast cancer, large Canadian and United Kingdom trials have shown no difference between conventional and hypofractionated treatment in local recurrence, overall survival, or cosmetic outcome at 10 years.…”