Alternatives to Standard Fractionation Radiation Therapy After Lumpectomy: Hypofractionated Whole-Breast Irradiation and Accelerated Partial-Breast Irradiation

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Key points

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    Adjuvant whole-breast irradiation after lumpectomy has been an established standard of care to optimize local tumor control for decades.

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    Standard-fractionation whole-breast irradiation delivered over 5 to 7 weeks can achieve durable tumor control with low toxicity and favorable cosmesis but can be inconvenient and cost ineffective.

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    Hypofractionated whole-breast irradiation can be completed in 3 to 4 weeks and is the preferred standard of care in appropriately selected patients.

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    Accelerated partial

Hypofractionated whole-breast irradiation

HF-WBI refers to the delivery of adjuvant whole-breast RT in a shortened 3- to 4-week course of treatment. The evidence in support of HF-WBI comes from a series of large randomized trials showing equivalence in efficacy, toxicity, and long-term cosmesis compared with SF-WBI. Key features and results of each trial are summarized in Tables 1 and 2.

Efficacy of hypofractionated whole-breast irradiation

One of the earlier HF-WBI trials was initiated in 1986 at the Royal Marsden Hospital and Gloucester Oncology Center (RMH/GOC) in the United Kingdom. This was a pilot trial that included 1410 patients younger than 75 years of age with T1-3, N0-1, M0 breast cancer who underwent BCS with complete macroscopic resection of invasive carcinoma. Patients were randomly assigned to 3 radiation dose schedules all delivered over 5 weeks. The control arm consisted of 50 Gy in 25 daily fractions. The 2

Summary

Adjuvant whole-breast irradiation after BCS has been an established standard of care to optimize local tumor control for decades. Although SF-WBI can achieve excellent durable tumor control with low toxicity and favorable cosmesis, a 5- to 7-week treatment regimen can be inconvenient for patients and may be an ineffective use of available resources.

HF-WBI presents an appealing alternate treatment regimen and may be considered the preferred standard of care in appropriately selected patients.

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