The Breast
Volume 19, Issue 3 , Pages 159-162 , June 2010

Fewer fractions of adjuvant external beam radiotherapy for early breast cancer are safe and effective and can now be the standard of care: Why the UK’s NICE accepts fewer fractions as the standard of care for adjuvant radiotherapy in early breast cancer

References 

  1. National Institute for Health and Clinical Excellence . Early and locally advanced breast cancer: diagnosis and treatment. (Clinical guideline). London: NICE; 2009;
  2. Early Breast Cancer Trialists’ Collaborative Group . Radiotherapy for early breast cancer. Art. No.: CD003647 Cochrane Database Syst Rev. 2002;(2):CD003647
  3. Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002;52:277–300
  4. Shelley W, Trudeau M. Cancer Care Ontario Practice Guidelines Initiative Breast irradiation in women with early stage invasive breast cancer following breast conserving surgery. Practice Guideline Report; 2002. p. 1–2.
  5. Overgaard M, Jensen MB, 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. Lancet. 1999;353(9165):1641–1648
  6. Overgaard M, Nielsen HM, Overgaard J. Is the benefit of postmastectomy irradiation limited to patients with four or more positive nodes, as recommended in international consensus reports? a subgroup analysis of the DBCG 82 b & c randomized trials. Radiother Oncol. 2007;82(3):247–253
  7. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM. 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;97(2):116–126
  8. Department of Health . Cancer reform strategy. London: DoH; 2007;
  9. Brachytherapy as the sole method of adjuvant radiotherapy for breast cancer after local excision. NICE interventional procedure guidance London: National Institute for Health and Clinical Excellence; 2008;268
  10. National Institute for Health and Clinical Excellence . Advanced breast cancer: diagnosis and treatment. (Clinical guideline). London: NICE; 2009;
  11. NICE website. www.nice.org.uk
  12. 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;94(15):1143–1150
  13. 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;75(1):9–17
  14. 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;7(6):467–471
  15. The START Trialists’ Group . The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008;9(4):331–341
  16. The START Trialists’ Group . The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;371(9618):1098–1107
  17. Bates TD. The 10-year results of a prospective trial of post-operative radiotherapy delivered in 3 fractions per week versus 2 fractions per week in breast carcinoma. Br J Radiol. 1988;61(727):625–630
  18. Goel A, Kaushal V, Hooda HS, Das BP. Comparison of two radiation dose schedules in post mastectomy carcinoma of the breast. Indian J Med Sci. 2000;54(7):278–283
  19. Taher AN, El-Baradie MM, Essa H, Zaki O, Ezzat S. Hypofractionation versus conventional fractionation radiotherapy after conservative treatment of breast cancer: early skin reactions and cosmetic results. J Egypt Natl Canc Inst. 2004;16(3):178–187
  20. Williams MV, James ND, Summers ET, Barrett A, Ash DV. National survey of radiotherapy fractionation practice in 2003. Clin Oncol. 2006;18:3–14
  21. Williams MV, Drinkwater KJ. Radiotherapy in England in 2007: modelled demand and audited activity. Clin Oncol. 2009;21:575–590
  22. Yarnold J. Personnel communication. Advances in radiotherapy: Head and Neck cancer and breast cancer. Newcastle; October 2009.

PII: S0960-9776(10)00103-7

doi: 10.1016/j.breast.2010.03.029

The Breast
Volume 19, Issue 3 , Pages 159-162 , June 2010

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