Hypofractionated radiation therapy for early breast cancer

Abstract

We found that using altered fraction size regimens (greater than 2 Gy per fraction) does not have a clinically meaningful effect on local recurrence, is associated with decreased acute toxicity and does not seem to affect breast appearance, late toxicity or patient-reported quality-of-life measures for selected women treated with breast conserving therapy. These are mostly women with node negative tumours smaller than 3 cm and negative pathological margins.

Reply to: The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice

“…The authors showed that moderate hypofractionation results in a lower radiogenic burden on heart structures as compared to conventional fractionation. In our opinion the calculations previously published by Loap et al [5] are in line with the results from Appelt et al Also, long-term data from trials with moderate hypofractionation [6,7] demonstrate that no increased cardiac toxicity is to be expected [8].…”

“…[ 5 ] are in line with the results from Appelt et al. Also, long-term data from trials with moderate hypofractionation [ 6 , 7 ] demonstrate that no increased cardiac toxicity is to be expected [ 8 ].…”

Reply to: The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice

“…The authors showed that moderate hypofractionation results in a lower radiogenic burden on heart structures as compared to conventional fractionation. In our opinion the calculations previously published by Loap et al [5] are in line with the results from Appelt et al Also, long-term data from trials with moderate hypofractionation [6,7] demonstrate that no increased cardiac toxicity is to be expected [8].…”

“…[ 5 ] are in line with the results from Appelt et al. Also, long-term data from trials with moderate hypofractionation [ 6 , 7 ] demonstrate that no increased cardiac toxicity is to be expected [ 8 ].…”

Long‐term results from a series of patients managed with breast conservation surgery and hypofractionated radiotherapy in Christchurch: What is the recurrence rate and how do we detect recurrences

“…11 The American Society of Clinical Oncology (ASCO) 2013 guideline states that patients with early breast cancer may be followed up by General Practitioner (GP) a year after diagnosis. 5,12,13 This is similar to Australian guideline for early breast cancer follow-up. 14 The optimal duration of follow-up remains undefined, with most recurrences within ten years, but still occurring out to 24 years especially in the setting of ER-positive disease.…”

Breast radiotherapy in elderly women: myths, controversies, and current techniques in the adjuvant setting

“…The START A, START B and the Canadian study all found that these treatments were therapeutically equivalent in terms of LC and OS outcomes, with a trend towards better acute cosmesis for the hypofractionated regimens, without significant differences in chronic toxicity ( 85 - 88 ) ( Table 2 ) or cardiac toxicity in left BC ( 89 ). The results of these studies were reanalyzed in several meta-analyses ( 90 - 92 ), which confirmed the findings. As a result, this hypofractionation schedule is now considered standard and supported by level 1 evidence in patients in whom irradiation of the breast or mastectomy bed is indicated ( 93 - 96 ).…”

Reply to: The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice

“…The authors showed that moderate hypofractionation results in a lower radiogenic burden on heart structures as compared to conventional fractionation. In our opinion the calculations previously published by Loap et al [5] are in line with the results from Appelt et al Also, long-term data from trials with moderate hypofractionation [6,7] demonstrate that no increased cardiac toxicity is to be expected [8].…”

“…[ 5 ] are in line with the results from Appelt et al. Also, long-term data from trials with moderate hypofractionation [ 6 , 7 ] demonstrate that no increased cardiac toxicity is to be expected [ 8 ].…”

Long‐term results from a series of patients managed with breast conservation surgery and hypofractionated radiotherapy in Christchurch: What is the recurrence rate and how do we detect recurrences

“…11 The American Society of Clinical Oncology (ASCO) 2013 guideline states that patients with early breast cancer may be followed up by General Practitioner (GP) a year after diagnosis. 5,12,13 This is similar to Australian guideline for early breast cancer follow-up. 14 The optimal duration of follow-up remains undefined, with most recurrences within ten years, but still occurring out to 24 years especially in the setting of ER-positive disease.…”

Breast radiotherapy in elderly women: myths, controversies, and current techniques in the adjuvant setting

“…The START A, START B and the Canadian study all found that these treatments were therapeutically equivalent in terms of LC and OS outcomes, with a trend towards better acute cosmesis for the hypofractionated regimens, without significant differences in chronic toxicity ( 85 - 88 ) ( Table 2 ) or cardiac toxicity in left BC ( 89 ). The results of these studies were reanalyzed in several meta-analyses ( 90 - 92 ), which confirmed the findings. As a result, this hypofractionation schedule is now considered standard and supported by level 1 evidence in patients in whom irradiation of the breast or mastectomy bed is indicated ( 93 - 96 ).…”

Reply to: The challenge of cardiac dose constraint adaptation to hypofractionated breast radiotherapy in clinical practice

“…The authors showed that moderate hypofractionation results in a lower radiogenic burden on heart structures as compared to conventional fractionation. In our opinion the calculations previously published by Loap et al [5] are in line with the results from Appelt et al Also, long-term data from trials with moderate hypofractionation [6,7] demonstrate that no increased cardiac toxicity is to be expected [8].…”

“…[ 5 ] are in line with the results from Appelt et al. Also, long-term data from trials with moderate hypofractionation [ 6 , 7 ] demonstrate that no increased cardiac toxicity is to be expected [ 8 ].…”

Long‐term results from a series of patients managed with breast conservation surgery and hypofractionated radiotherapy in Christchurch: What is the recurrence rate and how do we detect recurrences

“…11 The American Society of Clinical Oncology (ASCO) 2013 guideline states that patients with early breast cancer may be followed up by General Practitioner (GP) a year after diagnosis. 5,12,13 This is similar to Australian guideline for early breast cancer follow-up. 14 The optimal duration of follow-up remains undefined, with most recurrences within ten years, but still occurring out to 24 years especially in the setting of ER-positive disease.…”

Breast radiotherapy in elderly women: myths, controversies, and current techniques in the adjuvant setting

“…The START A, START B and the Canadian study all found that these treatments were therapeutically equivalent in terms of LC and OS outcomes, with a trend towards better acute cosmesis for the hypofractionated regimens, without significant differences in chronic toxicity ( 85 - 88 ) ( Table 2 ) or cardiac toxicity in left BC ( 89 ). The results of these studies were reanalyzed in several meta-analyses ( 90 - 92 ), which confirmed the findings. As a result, this hypofractionation schedule is now considered standard and supported by level 1 evidence in patients in whom irradiation of the breast or mastectomy bed is indicated ( 93 - 96 ).…”