Practice 5
Appropriate to offer a shorter, more intense course of radiotherapy (hypofractionated radiotherapy) as an alternative to conventional radiotherapy for patients with early breast cancer who:
- are aged 50 years and over;
- have a cancer at an early pathological stage (T1-2, N0, M0); and
- have undergone breast conserving surgery with clear surgical margins.
Context
External beam radiotherapy to the whole breast after breast conserving surgery is effective in reducing the risk of local recurrence and improving the survival of appropriately selected patients with early breast cancer.
External beam radiotherapy uses high-energy X-rays to destroy breast cancer cells, and is traditionally delivered by repeated small, daily doses of radiation to the breast over several weeks. Several clinical trials have shown that, in selected patients, higher daily doses of radiation over a shorter time period (known as hypofractionated radiotherapy) is equally as effective as the conventional approach in terms of local and distant recurrence, cosmetic outcomes and overall survival.
For women outside the above criteria with early breast cancer who require post-operative, whole breast radiotherapy, hypofractionated radiotherapy could be considered as an alternative to conventionally fractionated radiotherapy.
Value to patients
Because there are fewer days of treatment, hypofractionated radiotherapy may be more convenient for patients, and may influence their choice of surgical management. Consideration of hypofractionated radiotherapy and discussion of this approach with eligible patients will help ensure that patients can make an informed decision about their management.
Supporting evidence
Budach W, Bölke E, Matuschek C. Hypofractionated radiotherapy as adjuvant treatment in early breast cancer. A review and meta-analysis of randomized controlled trials. Breast Care (Basel). 2015 Aug;10(4):240-5.
Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378(9804):1707-16.
Hoopes DJ, Kaziska D, Chapin P, et al. Patient preferences and physician practice patterns regarding breast radiotherapy. International Journal of Radiation Oncology, Biology, Physics. 2012 Feb 1;82(2):674-81.
Linares I, Tovar MI, Zurita M, et al. Hypofractionated breast radiation: Shorter scheme, lower toxicity. Clinical Breast Cancer. 2015 Sep 25. pii: S1526-8209(15)00223-2.