Evaluating Safety and Effectiveness of Hypofractionated Radiotherapy for Early Breast Cancer

BACKGROUND:With whole breast irradiation ,tumor doses of approximately 45 to 50 GY are delivered to the entire breast over 5 to 6 weeks,5 weekly fractions. Alternative fractionation schemes have been employed and have been shown to be acceptable. Randomised trials, including START, indicate that a lower total dose delivered in fewere, larger fractions is likely to be at least as safe and effective. METHODS:For this review,computerized literature searches of MEDLINE and Cochrane Collaboration Library were conducted.Searche terms included the following: START trial , Hypofractionation radiotherapy RESULTS and FINDINGS:The proportion of patients with local-regional relapse at 10 years follow-up did not differ significantly between the 40 GY in 15 fractions over 3 weeks group(4.3%, 95% CI 3.2-5.9)and the 50GY in 25 fractions over 5 weeks group(5.5% ,95% CI 4.2-7.2;HR 0.77 ,95% CI 0.51-1.16 ;p=0.21). Breast shrinkage ,telangiectasia, and breast oedema were significantly less common normal tissue effects in the 40 GY group relative to the 50 GY group . CONCLUSION:After nearly ten years follow up the authores concluded that appropriately dosed hypofractionated radiotherapy is safe and effective in treatment of patients with early breast cancer.The results support the continued use of 40GY in15 fractions over 3 weeks as standard of care for adjuvantradiotherapy for early breast cancer.