Abstract
Since the advent of breast conservation, adjuvant radiation therapy (RT) has been
standard of care following breast conserving surgery (BCS). Radiation therapy following
BCS has traditionally been whole breast irradiation (WBI); studies comparing breast
conservation to mastectomy utilized standard fractionation WBI, which delivers treatment
daily over 5 to 7 weeks (1.8-2 Gy/fraction) and was the standard for decades. More
recently, multiple randomized trials have compared standard fractionation WBI to moderately
hypofractionated WBI (2.66 Gy/fraction, 15-16 fractions), which allows for completion
of treatment in 3 to 4 weeks. Results have demonstrated no difference in local control
between these two approaches with comparable toxicity and cosmetic outcomes with long-term
follow-up. As such, moderately hypofractionated WBI represents the standard of care
approach for most patients with early-stage breast cancer following BCS at this time.
In the past few years, ultra-hypofractionated WBI (5.2-5.7 Gy/fraction, 5 fractions)
has emerged with promising outcomes; 5-year outcomes from the FAST-Forward randomized
trial demonstrated noninferiority between ultra-hypofractionated WBI and moderately
hypofractionated WBI. Moving forward, long-term outcomes from ultra-hypofractionated
WBI studies are expected, as well as the potential for incorporating moderately hypofractionated
regimens into patients requiring regional nodal irradiation following BCS. Finally,
the advent of ultra-short regimens may allow clinicians to re-evaluate treatment de-intensification
in early-stage breast cancer to consider radiation therapy alone following BCS in
lieu of endocrine therapy.
Keywords
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Article info
Publication history
Published online: January 26, 2023
Accepted:
January 23,
2023
Received in revised form:
January 21,
2023
Received:
December 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
