The Breast
Volume 19, Issue 3 , Pages 176-179 , June 2010

Pushing the limits of hypofractionation for adjuvant whole breast radiotherapy

  • John Yarnold

      Affiliations

    • Section of Radiotherapy, Institute of Cancer Research and Royal Marsden Hospital, Sutton, UK
    • Corresponding Author InformationCorresponding author at: Section of Academic Radiotherapy, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK. Tel.: +44 20 8661 3388; fax: +44 20 8661 3107.
    • ,
  • Joanne Haviland

      Affiliations

    • Clinical Trials and Statistics Unit, (ICR-CTSU), Institute of Cancer Research, Sutton, UK

References 

  1. Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bentzen SM, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008 Mar 29;371(9618):1098–1107
  2. Harnett A, Smallwood J, Titshall V, Champion A. Diagnosis and treatment of early breast cancer, including locally advanced disease-summary of NICE guidance. BMJ. 2009;338:b438
  3. Yarnold J, Ashton A, Bliss J, Homewood J, Harper C, Hanson J, et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol. 2005 Apr;75(1):9–17
  4. Collette S, Collette L, Budiharto T, Horiot JC, Poortmans PM, Struikmans H, et al. Predictors of the risk of fibrosis at 10 years after breast conserving therapy for early breast cancer: a study based on the EORTC Trial 22881-10882 ‘boost versus no boost’. Eur J Cancer. 2008 Nov;44(17):2587–2599
  5. McGale P, Darby SC. Low doses of ionizing radiation and circulatory diseases: a systematic review of the published epidemiological evidence. Radiat Res. 2005 Mar;163(3):247–257
  6. Taylor CW, Nisbet A, McGale P, Darby SC. Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Radiat Oncol Biol Phys. 2007 Dec 1;69(5):1484–1495
  7. Withers HR. Biological basis of radiation therapy for cancer. Lancet. 1992 Jan 18;339(8786):156–159
  8. Jones B, Dale RG, Finst P, Khaksar SJ. Biological equivalent dose assessment of the consequences of hypofractionated radiotherapy. Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1379–1384
  9. Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007 Mar;82(3):254–264
  10. Turesson I, Thames HD. Repair capacity and kinetics of human skin during fractionated radiotherapy: erythema, desquamation, and telangiectasia after 3 and 5 year’s follow-up. Radiother Oncol. 1989 Jun;15(2):169–188
  11. Brunt AM, Sydenham M, Bliss J, Coles C, Gothard L, Haviland J, et al. A 5-fraction regimen of adjuvant radiotherapy for women with early breast cancer: first analysis of the randomised UK FAST trial (ISRCTN62488883, CRUKE/04/015). Presidential sessions late breaking and best of ECCO 15-ESMO 34 Abstracts EJC Supplements. 2009;7(2):
  12. Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol. 2006 Jun;7(6):467–471
  13. Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM, et al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008 Apr;9(4):331–341
  14. Williams MV, Denekamp J, Fowler JF. A review of alpha/beta ratios for experimental tumors: implications for clinical studies of altered fractionation. Int J Radiat Oncol Biol Phys. 1985 Jan;11(1):87–96
  15. Nyman J, Turesson I. Basal cell density in human skin for various fractionation schedules in radiotherapy. Radiother Oncol. 1994 Nov;33(2):117–124
  16. Martin S, Mannino M, Rostom A, Tait D, Donovan E, Eagle S, et al. Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer. Clin Oncol (R Coll Radiol). 2008 Sep;20(7):502–505
  17. Thames HD, Withers HR, Peters LJ, Fletcher GH. Changes in early and late radiation responses with altered dose fractionation: implications for dose–survival relationships. Int J Radiat Oncol Biol Phys. 1982 Feb;8(2):219–226
  18. Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999 Apr 3;353(9159):1119–1126
  19. Bentzen SM, Dische S, Bond S. Delay in diagnosis in breast cancer. Lancet. 1999 Jun 19;353(9170):2155–2156
  20. Buchholz TA, Austin-Seymour MM, Moe RE, Ellis GK, Livingston RB, Pelton JG, et al. Effect of delay in radiation in the combined modality treatment of breast cancer. Int J Radiat Oncol Biol Phys. 1993 Apr 30;26(1):23–35
  21. Hebert-Croteau N, Freeman CR, Latreille J, Brisson J. Delay in adjuvant radiation treatment and outcomes of breast cancer – a review. Breast Cancer Res Treat. 2002 Jul;74(1):77–94
  22. Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol. 2003 Feb 1;21(3):555–563
  23. Ploquin NP, Dunscombe PB. The cost of radiation therapy. Radiother Oncol. 2008 Feb;86(2):217–223
  24. RTOG. Radiation Therapy Oncolgoy Group (RTOG). NSAPB PROTOCOL B-39. RTOG PROTOCOL 0413. A Randomized Phase III Study of Conventional Whole Breast Irradiation (WBI) Versus Partial Breast Irradiation (PBI) for Women with Stage 0, I, or II Breast Cancer. National Surgical Adjuvant Breast and Bowel Project (NSABP). Version date March 13; 2007. http://www.rtog.org.
  25. Bentzen SM, Saunders MI, Dische S. Repair halftimes estimated from observations of treatment-related morbidity after CHART or conventional radiotherapy in head and neck cancer. Radiother Oncol. 1999 Dec;53(3):219–226
  26. Vicini FA, Chen P, Wallace M, Mitchell C, Hasan Y, Grills I, et al. Interim cosmetic results and toxicity using 3D conformal external beam radiotherapy to deliver accelerated partial breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys. 2007 Nov 15;69(4):1124–1130
  27. Polgar C, Fodor J, Major T, Nemeth G, Lovey K, Orosz Z, et al. Breast-conserving treatment with partial or whole breast irradiation for low-risk invasive breast carcinoma – 5-year results of a randomized trial. Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):694–702
  28. Orecchia R, Ciocca M, Lazzari R, Garibaldi C, Leonardi MC, Luini A, et al. Intraoperative radiation therapy with electrons (ELIOT) in early-stage breast cancer. Breast. 2003 Dec;12(6):483–490
  29. Luini A, Orecchia R, Gatti G, Intra M, Ciocca M, Galimberti V, et al. The pilot trial on intraoperative radiotherapy with electrons (ELIOT): update on the results. Breast Cancer Res Treat. 2005 Sep;93(1):55–59
  30. Holmes DR, Baum M, Joseph D. The TARGIT trial: targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update). Am J Surg. 2007 Oct;194(4):507–510
  31. Courdi A, Ortholan C, Hannoun-Levi JM, et al. Long-term results of hypofractionated radiotherapy and hormonal therapy without surgery for breast cancer in elderly patients. Radiother Oncol. 2006;79:156–161
  32. Kirova YM, Campana F, Savignoni A, Laki F, Muresan M, Dendale R, et al. Breast-conserving treatment in the elderly: long-term results of adjuvant hypofractionated and normofractionated radiotherapy. Int J Radiat Oncol Biol Phys. 2009 Sep 1;75(1):76–81
  33. Campana F, Kirova YM, Rosenwald JC, Dendale R, Vilcoq JR, Dreyfus H, et al. Breast radiotherapy in the lateral decubitus position: a technique to prevent lung and heart irradiation. Int J Radiat Oncol Biol Phys. 2005 Apr 1;61(5):1348–1354

PII: S0960-9776(10)00055-X

doi: 10.1016/j.breast.2010.03.001

The Breast
Volume 19, Issue 3 , Pages 176-179 , June 2010

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