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Hypofractionation in radiotherapy for breast cancer
749 women were assigned to the 50 Gy group, 750 to the 41·6 Gy group, and 737 to the 39 Gy group. After a median follow up of 5·1 years (IQR 4·4–6·0) the rate of local-regional tumour relapse at 5 years was 3·6%(95%CI 2·2–5·1) after 50 Gy, 3·5%(95%CI 2·1–4·3) after 41·6 Gy, and 5·2%(95%CI 3·5–6·9) after 39 Gy. The estimated absolute differences in 5-year local-regional relapse rates compared with 50 Gy were 0·2%(95%CI −1·3%to 2·6%) after 41·6 Gy and 0·9%(95%CI −0·8%to 3·7%) after 39 Gy. Photographic and patient self-assessments suggested lower rates of late adverse effects after 39 Gy than with 50 Gy, with an HR for late change in breast appearance (photographic) of 0·69 (95%CI 0·52–0·91, p=0·01). From a planned meta-analysis with the pilot trial, the adjusted estimates of α/β value for tumour control was 4·6 Gy (95%CI 1·1–8·1) and for late change in breast appearance (photographic) was 3·4 Gy (95%CI 2·3–4·5).
The data are consistent with the hypothesis that breast cancer and the dose-limiting normal tissues respond similarly to change in radiotherapy fraction size. 41·6 Gy in 13 fractions was similar to the control regimen of 50 Gy in 25 fractions in terms of local-regional tumour control and late normal tissue effects, a result consistent with the result of START Trial B. A lower total dose in a smaller number of fractions could offer similar rates of tumour control and normal tissue damage as the international standard fractionation schedule of 50 Gy in 25 fractions.
top" style="padding: 5px 5px 0px 5px">![]() | The UK Standardisation of Breast Radiotherapy (START) T... The Lancet |
![]() The Lancet, Volume 371, Issue 9618, 29 March 2008-4 April 2008, Pages 1098-1107 The START Trialists' Group Abstract SummaryBackgroundThe international standard radiotherapy schedule for early breast cancer delivers 50 Gy in 25 fractions of 2·0 Gy over 5 weeks, but there is a long history of non-standard regimens delivering a lower total dose using fewer, larger fractions (hypofractionation). We aimed to test the benefits of radiotherapy schedules using fraction sizes larger than 2·0 Gy in terms of local-regional tumour control, normal tissue responses, quality of life, and economic consequences in women prescribed post-operative radiotherapy. |
top" style="padding: 5px 5px 0px 5px">![]() | Acute Toxicity and 2 Clinical Oncology |
![]() Clinical Oncology, In Press, Corrected Proof, Available online 16 June 2008 S. Martin, M. Mannino, A. Rostom, D. Tait, E. Donovan, S. Eagle, J. Haviland, J. Yarnold Abstract AimsA pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer.Materials and methodsThirty women with early invasive breast cancer aged ≥50 years with a pathological tumour size <3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6–10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0 = none, 1 = mild, 2 = moderate, 3 = severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years. ResultsNine patients (30%, 95%confidence interval 14.7–49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95%confidence interval 3.7–30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95%confidence interval 9.9–42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1–3.9 years) there have been no ipsilateral local tumour relapses. ConclusionsFurther evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days. ![]() |
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Hypofractionation in radiotherapy for breast cancer