Hypofractionated Whole Breast Radiation Suitable for Many, New ASTRO Guidelines State

Hypofractionated Whole Breast Radiation Suitable for Many, New ASTRO Guidelines State

Hypofractionated (HF) whole breast irradiation (WBI) is effective for many patients with early-stage breast cancer, according to new evidence-based guidelines issued by the American Society for Radiation Oncology (ASTRO).

The guidelines, published online in the International Journal of Radiation Oncology∙Biology∙Physics, the official ASTRO journal, define appropriate fractionation of WBI.

WBI following breast-conserving surgery has been shown to lower the risk of tumor recurrence and improve survival. Conventionally fractionated (CF) radiation involves daily treatments for up to 7 weeks and so can be costly and inconvenient for the patient. HF-WBI, in contrast, uses a higher dose of radiation per treatment but fewer total treatments so patients can typically finish radiation in 4 weeks or less.

Several studies have found little difference in local control and survival outcomes for selected patients treated with CF-WBI or HF-WBI.

The ASTRO task force concluded that HF-WBI is just as effective as CF-WBI for patients with early-stage breast cancer who meet certain criteria, including:

Age ≥50 years

Stage T1-2 N0

Not receiving chemotherapy

Relatively uniform delivery of the radiation dose

Ability to exclude the heart from the path of the radiation beam

There was insufficient evidence for the panel to reach a consensus for or against the use of HF-WBI for patients not meeting these criteria.

“Widespread adoption of HF-WBI for appropriately selected patients has the potential to enhance the convenience of treatment and lower the costs of WBI,” said Benjamin D. Smith, lead author of the guidelines and a radiation oncologist at the University of Texas M.D. Anderson Cancer Center in Houston. For patients who do not meet the criteria, he added, HF-WBI can be considered an option but further research is needed.

Hypofractionated Whole Breast Radiation Suitable for Many, New ASTRO Guidelines State

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