The Breast
Volume 19, Issue 3 , Pages 163-167 , June 2010

Hypofractionation should be the new ‘standard’ for radiation therapy after breast conserving surgery

References 

  1. Whelan T, Olivotto I, Levine M. Health Canada’s steering committee on clinical practice guidelines for the care and treatment of breast cancer. Clinical practice guidelines for the care and treatment of breast cancer: breast radiotherapy after breast-conserving surgery (summary of the 2003 update). CMAJ. 2003 Feb 18;168(4):437–439
  2. Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2009 Feb;7(2):122–192
  3. Harnett A, Smallwood J, Titshall V, Champion A. Guideline development group. Diagnosis and treatment of early breast cancer, including locally advanced disease–summary of NICE guidance. BMJ. 2009 Feb 25;338:b438
  4. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005 Dec 17;366(9503):2087–2106
  5. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–1241
  6. Liljegren G, Holmberg L, Bergh J, Lindgren A, Tabar L, Nordgren H, et al. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol. 1999;17(8):2326–2333
  7. Renton SC, Gazet JC, Ford HT, Corbishley C, Sutcliffe R. The importance of the resection margin in conservative surgery for breast cancer. Eur J Surg Oncol. 1996 Feb;22(1):17–22
  8. Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, Harnett AN, et al. Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish cancer trials breast group. Lancet. 1996 Sep 14;348(9029):708–713
  9. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–1232
  10. Sarrazin D, Le MG, Arriagada R, Contesso G, Fontaine F, Spielmann M, et al. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol. 1989 Mar;14(3):177–184
  11. Holli K, Hietanen P, Saaristo R, Huhtala H, Hakama M, Joensuu H. Radiotherapy after segmental resection of breast cancer with favorable prognostic features: 12-year follow-up results of a randomized trial. J Clin Oncol. 2009 Feb 20;27(6):927–932
  12. Malmstrom P, Holmberg L, Anderson H, Mattsson J, Jonsson PE, Tennvall-Nittby L, et al. Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: a randomised clinical trial in a population with access to public mammography screening. Eur J Cancer. 2003 Aug;39(12):1690–1697
  13. Fyles AW, McCready DR, Manchul LA, Trudeau ME, Merante P, Pintilie M, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med. 2004 Sep 2;351(10):963–970
  14. Clark RM, Whelan T, Levine M, Roberts R, Willan A, McCulloch P, et al. Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario clinical oncology group. J Natl Cancer Inst. 1996 Nov 20;88(22):1659–1664
  15. Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004 Sep 2;351(10):971–977
  16. Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985 Mar 14;312(11):665–673
  17. Shelley W, Brundage M, Hayter C, Paszat L, Zhou S, Mackillop W. A shorter fractionation schedule for postlumpectomy breast cancer patients. Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1219–1228
  18. Olivotto IA, Weir LM, Kim-Sing C, Bajdik CD, Trevisan CH, Doll CM, et al. Late cosmetic results of short fractionation for breast conservation. Radiother Oncol. 1996 Oct;41(1):7–13
  19. 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
  20. Fujii O, Hiratsuka J, Nagase N, Tokiya R, Yoden E, Sonoo H, et al. Whole-breast radiotherapy with shorter fractionation schedules following breast-conserving surgery: short-term morbidity and preliminary outcomes. Breast Cancer. 2008;15(1):86–92
  21. Froud PJ, Mates D, Jackson JS, Phillips N, Andersen S, Jackson SM, et al. Effect of time interval between breast-conserving surgery and radiation therapy on ipsilateral breast recurrence. Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):363–372
  22. Kuusk U, Basco V, Rebbeck P. Comparison of partial and modified radical mastectomy in the community setting – “10 years later”. Can J Surg. 1992 Aug;35(4):383–387
  23. Harris JR. Notes on the Ontario trial in the context of breast-conserving therapy for early-stage breast cancer. J Clin Oncol. 2000 Nov 1;18(21 Suppl.):43S–44S
  24. Rose MA, Olivotto I, Cady B, Koufman C, Osteen R, Silver B, et al. Conservative surgery and radiation therapy for early breast cancer. Long-term cosmetic results. Arch Surg. 1989 Feb;124(2):153–157
  25. Boyages J, Langlands AO. Breast cancer: the role of radiation therapy after treatment by conservative surgery. Aust N Z J Surg. 1992 Jun;62(6):422–428
  26. Solin LJ, Schultz DJ, Fowble BL. Ten-year results of the treatment of early-stage breast carcinoma in elderly women using breast-conserving surgery and definitive breast irradiation. Int J Radiat Oncol Biol Phys. 1995 Aug 30;33(1):45–51
  27. Whelan TJ, Kim DH, Sussman J. Clinical experience using hypofractionated radiation schedules in breast cancer. Semin Radiat Oncol. 2008 Oct;18(4):257–264
  28. Whelan T, MacKenzie R, Julian J, Levine M, Shelley W, Grimard L, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002 Aug 7;94(15):1143–1150
  29. START Trialists’ Group , Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, 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
  30. START Trialists’ Group , Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, 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
  31. 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
  32. Douglas BG, Castro JR. Novel fractionation schemes and high linear energy transfer. Prog Exp Tumor Res. 1984;28:152–165
  33. Cohen L. Radiotherapy in breast cancer. I. The dose–time relationship theoretical considerations. Br J Radiol. 1952 Dec;25(300):636–642
  34. Hopwood P, Haviland JS, Sumo G, Mills J, Bliss JM, Yarnold JR, et al. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol. 2010 Feb 5;
  35. Whelan TJ, Pignol JP, Levine MN, Julian JA, Mackenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010 Feb 11;362(6):513–520
  36. James ML, Lehman M, Hider PN, Jeffery M, Francis DP, Hickey BE. Fraction size in radiation treatment for breast conservation in early breast cancer. Cochrane Database Syst Rev. 2008 Jul 16;3(3):CD003860
  37. Bartelink H, Horiot JC, Poortmans PM, Struikmans H, Van den Bogaert W, Fourquet A, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007 Aug 1;25(22):3259–3265
  38. Dewar JA, Benhamou S, Benhamou E, Arriagada R, Petit JY, Fontaine F, et al. Cosmetic results following lumpectomy, axillary dissection and radiotherapy for small breast cancers. Radiother Oncol. 1988 Aug;12(4):273–280
  39. Fehlauer F, Tribius S, Alberti W, Rades D. Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy. Strahlenther Onkol. 2005 Oct;181(10):625–631
  40. Pignol JP, Olivotto I, Rakovitch E, Gardner S, Sixel K, Beckham W, et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol. 2008 May 1;26(13):2085–2092
  41. Ragaz J, Jackson SM, Le N, Plenderleith IH, Spinelli JJ, Basco VE, et al. Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer. N Engl J Med. 1997 Oct 2;337(14):956–962
  42. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005 Jan 19;97(2):116–126
  43. Overgaard M, Jensen M-B, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: danish breast cancer cooperative group DBCG 82c randomised trial. Lancet. 1999;353(9165):1641–1648
  44. Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, et al. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish breast cancer cooperative group 82b trial. N Engl J Med. 1997 Oct 2;337(14):949–955
  45. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol. 2000 Mar;18(6):1220–1229
  46. Gebski V, Lagleva M, Keech A, Simes J, Langlands AO. Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses: a clinical perspective. J Natl Cancer Inst. 2006 Jan 4;98(1):26–38
  47. Bates T, Evans RG. Audit of brachial plexus neuropathy following radiotherapy. Clin Oncol (R Coll Radiol). 1995;7(4):236
  48. Galecki J, Hicer-Grzenkowicz J, Grudzien-Kowalska M, Michalska T, Zalucki W. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer – a review. Acta Oncol. 2006;45(3):280–284
  49. Nesvold IL, Dahl AA, Lokkevik E, Marit Mengshoel A, Fossa SD. Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy. Acta Oncol. 2008;47(5):835–842
  50. Stokes E, Tyldesley S, Wai E, Olivotto I. Impact of nodal irradiation and fraction size on cardiac and cerebrovascular mortality in women treated for localized and locoregional breast cancers. Radiother Oncol. 2008;88(Suppl. 1):S15–S16

PII: S0960-9776(10)00056-1

doi: 10.1016/j.breast.2010.03.002

The Breast
Volume 19, Issue 3 , Pages 163-167 , June 2010

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