5-Year Update of a Multi-Institution, Prospective Phase 2 Hypofractionated Postmastectomy Radiation Therapy Trial

Hypofractionated Postmastectomy Radiation Therapy

“…Long-term analysis of this trial additionally showed a low rate of grade 2 toxicities, including chest wall pain (8%), fatigue (3%), and lymphedema (2%). 39 …”

“…Although radiation-induced brachial plexopathy is a concern, this has become an increasingly rare entity in patients receiving HF-PMRT in the modern era ( Table 3 ). 8 , 31 , 37 , 39 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 According to Galecki et al, 51 the risk of radiation-induced plexopathy was less than 1% when the total dose administered was in the range of 34 to 40 Gy. Surgical manipulation and chemotherapy are additional factors that can lead to brachial plexopathy.…”

“… 37 However, in the US phase II HF-PMRT trial, 43 patients (45%) underwent breast reconstruction. 39 Reconstructions were commonly performed before HF-PMRT (93%) and consisted of temporary expanders (88%), permanent implants (7%), and prior augmentation implants (5%). A total of 35% of the patients had grade 3 or 4 reconstruction complications attributable to RT in this trial.…”

Moderate hypofractionation remains the standard of care for whole-breast radiotherapy in breast cancer: Considerations regarding FAST and FAST-Forward

“…This was based on the results from several well-powered randomized controlled trials showing comparable outcomes with regard to the risk of recurrence and chronic toxicity and with potential advantages in terms of reduced acute toxicity and improved cost-effectiveness [4][5][6][7][8][9][10][11][12]. First results on hypofractionated post-mastectomy radiotherapy have been published [13][14][15] with multiple trials on this topic and on hypofractionated regional nodal irradiation still ongoing. While there may be residual areas of debate, such as very young patients, rare histologic subtypes or patients with connective tissue diseases [16], there is now a broad consensus that moderate hypofractionation should be used preferentially after breast-conserving surgery when regional nodal irradiation is not indicated.…”

Genomically Guided Breast Radiation Therapy: A Review of the Current Data and Future Directions

“…The results of a phase III study conducted in China of hypofractionation (43.5 Gy in 15 daily fractions) vs. conventional fractionation (50 Gy in 25 daily fractions) in the post-mastectomy, unreconstructed setting delivered with electrons revealed no differences in LRR with a similar toxicity profile with approximately 5 years of follow-up [27]. A phase II trial of a shorter course of radiotherapy of 36.63 Gy in 11 fractions revealed low rates of toxicity and high local control with 5 years of followup [28,29]. The ongoing RT-CHARM (Alliance A221505, NCT03414970) and FABREC studies (NCT03422003) randomizes women treated with mastectomy and either immediate reconstruction or plans to undergo reconstruction within 18 months after radiation, with the primary endpoint of reconstruction complications.…”