Hypofractionated radiation treatment in the management of breast cancer

Abstract

The standard treatment for early-stage breast cancer is breast conservation therapy, consisting of breast conserving surgery followed by adjuvant radiation treatment (RT). Conventionally-fractionated whole breast irradiation (CF-WBI) has been the standard RT regimen, but recently shorter courses of hypofractionated whole breast irradiation (HF-WBI) have been advocated for patient convenience and reduction in healthcare costs and resources. Areas covered: This review covers the major randomized European and Canadian trials comparing HF-WBI to CF-WBI with long-term follow-up, as well as additional recently closed randomized trials that further seek to define the applicability of HF-WBI in clinical practice. Randomized data is summarized in terms of clinical utility and for a variety of clinical applications. Recently published consensus guidelines and practical implementation of HF-WBI including its broader effect on the healthcare system are reviewed. Finally, an assessment of the emerging evidence in support of hypofractionation for locally advanced disease is presented. Expert commentary: HF-WBI has replaced CF-WBI as the accepted standard of care in most women with early-stage breast cancer who do not require regional nodal irradiation. Early data supports the continued study of hypofractionation in the locally advanced setting, however broad adoption awaits longer follow-up and additional data from ongoing clinical trials.

The Characteristics Comparison of Breast Cancer Patients in Southern China and America: A Multicentre Study in China Versus SEER Database

“…In this study, BC patients enrolled in the study in southern China all underwent surgery, and the treatment including BCS and mastectomy (including SM and MRM). Among them, there were about 95.09% of BC patients performed mastectomy and 4.91% of that performed BCS, and the implementation rate of BCS was signi cantly lower than that of developed countries, which was similar to the results of Gupta A: the highest implementation rate of BCS in China is only 8.6% [48] . However, there were only 18.24% of BC patients performed mastectomy in SEER cohort, 81.76% of that had not.…”

“…But for SEER cohort had not include the details of surgical procedures, so its' effects on survival and prognosis of BC were not studied and analyzed, which may be a potential factor. In recent years, a number of large randomized trials have shown that radiotherapy could signi cantly reduce the local recurrence of BC, so as to improve the breast preservation rate and obtain good survival rate [48]. However, in this study, the radiotherapy rate of BC patients in southern China and SEER cohort were both not high, were 27.18% and 34.22% respectively, and there were signi cant statistical different between the two (P = 0.001).…”

“…Staging was performed according to the American Joint Committee on Cancer (AJCC) guidelines [32]. The age of the patients was classi ed to young adult group (<40), middle aged group (40-70) and aged+ group (>70), and then, calculated the median age of each age group (35,48,75), nally, statistical analysis was carried out respectively. A cutoff of 14% for KI-67 was used, which was recommended by 2011 St Gallen consensus panel [33], and then, we divided the group of KI-67≥14% into two subgroups, according to the median (51.7% in southern China).…”

Patterns of breast cancer radiotherapy practices among Saudi radiation oncologists

“…13 Hypofractionation at a dose of 40/15 or 42.5/16 is the standard of care after breast conservative surgery. 14 However, the use of hypofractionation for locoregional treatment as well as in the setting of PMRT with or without immediate reconstruction is controversial. 7 The Danish and Canadian postmastectomy landmark trials that revealed survival advantage following the addition of adjuvant radiation after mastectomy have actually delivered hypofractionated regimens.. 15,16 In the United Kingdom (UK), it is standard practice to offer hypofractionated radiotherapy to all patients in the adjuvant setting.…”

Non-ablative hypofractionated hemithoracic radiation—a new standard of care in mesothelioma?

“…The article published in Cancer Radiotherapy by Parisi and colleagues went one-step further and demonstrated the safety of hypofractionated hemithoracic radiation after PD in MPM using 25 Gy in 5 fractions (2). Hypofractionated rather than normofractionated radiation has been used in the adjuvant setting (for instance after surgery for breast cancer) to improve quality of life at less cost since a biologically equivalent dose of radiation can be reached in a shorter period of time (22). In the retrospective study from Parisi and colleagues, the rate of grade 1 pneumonitis was 97% in the acute phase and 47% in the late phase after radiation (2).…”