Hypofractionated radiation therapy for invasive breast cancer: From moderate to extreme protocols

Cancer Radiother. 2019 Dec;23(8):874-882. doi: 10.1016/j.canrad.2019.09.002. Epub 2019 Oct 11.

Abstract

Adjuvant irradiation is the standard treatment after breast conservative surgery. Normofractionated regimen with an overall treatment time of 5 to 6 weeks is often considered as a limiting factor for irradiation compliance. In order to answer this issue, moderate and more recently extreme hypofractionated protocols appeared. We report here oncological outcomes and toxicity of hypofractionated breast irradiation. After defining the frame of moderate and extreme hypofractionated breast irradiations based on overall treatment time, patient selection criteria were listed. According to their levels of proof, the results of moderate and extreme hypofractionated breast irradiation were analysed. Overall treatment time for moderate hypofractionated breast irradiation ranged from 3 to 4 weeks, while for extreme hypofractionated breast irradiation, it was less than 1 week. For moderate hypofractionated breast irradiation, whole breast irradiation was currently performed with or without lymph node irradiation. Moderate hypofractionated breast irradiation has proven to be as safe and as efficient as normofractionated breast irradiation with level IA evidence. For extreme hypofractionated breast irradiation, phase III randomized trials confirmed that accelerated partial breast irradiation was non-inferior in terms of local control compared to normofractionated whole breast irradiation (with external beam radiation therapy and multicatheter brachytherapy), with similar acute and late toxicity. While the use of intraoperative breast irradiation remains under debate, new very accelerated partial breast irradiation (overall treatment time not exceeding 2 days) protocols emerged with encouraging results. Accelerated partial breast irradiation is warranted for extreme hypofractionated breast irradiation and is indicated for low-risk breast cancers. Moderate and extreme hypofractionated breast irradiation regimens are validated and can be routinely proposed according to patient selection criteria.

Keywords: APBI; Breast cancer; Cancer du sein; Hypofractionated regimen; Irradiation partielle accélérée; Radiation therapy; Radiothérapie hypofractionnée.

Publication types

  • Review

MeSH terms

  • Brachytherapy / methods
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy*
  • Breast Neoplasms / surgery
  • Clinical Trials as Topic
  • Combined Modality Therapy
  • Conservative Treatment
  • Female
  • Humans
  • Lymphatic Irradiation
  • Middle Aged
  • Patient Selection
  • Radiation Dose Hypofractionation*
  • Radiotherapy, Adjuvant
  • Randomized Controlled Trials as Topic
  • Time Factors