Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer

Corrigan, Kelsey L.; Lei, Xiudong; Ahmad, Neelofur; Arzu, Isidora; Bloom, Elizabeth Stroh; Chun, Stephen G.; Goodman, Chelain R.; Hoffman, Karen E.; Joyner, Melissa; Mayo, Lauren L.; Mitchell, Melissa; Nead, Kevin T.; Perkins, George H.; Reed, Valerie Klairisa; Reddy, Jay P.; Schlembach, Pamela J.; Shaitelman, Simona F.; Stauder, Michael C.; Strom, Eric A.; Tereffe, Welela; Wiederhold, Lee; Woodward, Wendy A.; Smith, Benjamin D.

doi:10.1016/j.adro.2021.100877

Cited by 9 publications

(5 citation statements)

References 26 publications

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“…This article details our experience of developing and implementing a five-fraction adjuvant breast radiation protocol in an academic multisite radiation medicine department in the US. There continue to be differing practices between individual physicians regarding the use of five-fraction radiation for breast cancer [11], as was also the case in our department. Following a departmental survey and literature review, a consensus, evidenced-based treatment directive was agreed upon.…”

Section: Discussionmentioning

confidence: 77%

“…For example, five-fraction adjuvant radiation is listed in the 2022 National Comprehensive Cancer Network (NCCN) guidelines version 2.2022 as an alternative for select patients over 50 years of age with pTis/T1/T2/N0 breast cancer. Therefore, many US centers are now offering five-fraction radiation to select patients [11]. Whilst ultrahypofractionation may not be suitable for all patients [12], it offers a safe and effective alternative to longer protocols, with fewer treatment visits, reduced overall machine time, fewer travel requirements, less need for patients to request time away from work or caring responsibilities and offers reduced costs to healthcare providers and patients compared with longer regimens.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of External Beam Five-Fraction Adjuvant Breast Irradiation in a US Center

Eckstein

Taylor

Zheng

et al. 2022

Cancers

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Five-fraction adjuvant whole breast radiation has been shown to be a safe and effective alternative to longer fractionation regimens. Given the lack of international consensus on patient selection for the protocol, we developed a consensus protocol to guide patient selection and facilitate safe and efficient five-fraction radiation in our radiation medicine department. In developing the directive, we surveyed departmental physicians about their choice of adjuvant breast regimen for various clinical scenarios. Patient travel burden was the factor most strongly impacting radiation oncologists’ decision-making when considering prescribing a five-fraction course of adjuvant breast radiation; the length of clinical trial follow-up data and acute and late normal tissue effects also impacted it, along with personal clinical experience and experience of dosimetry and physics personnel. Relative value unit (RVU) reimbursement and financial toxicity to the patient were reported to be less important in decision-making. Physicians were most comfortable using five-fraction radiation in women >50 years of age with low-risk cancer and for patients unable to attend for longer treatment courses. Eight months after implementation, the protocol accounts for 4.7% of breast irradiation delivered in our department.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Implementation of External Beam Five-Fraction Adjuvant Breast Irradiation in a US Center

Eckstein

Taylor

Zheng

et al. 2022

Cancers

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“…23 In addition, older or frail patients with morbidities, or patients who have to travel a long distance to receive treatment are other clinical factors in which the use of this scheme should be considered. In a recent study, Corrigan et al 24 studied the characteristics associated with the use of ultrahypofractionated scheme at their centre. They identified that patients ≥50 years old, Breast pain (at 6 months)…”

Section: Discussionmentioning

confidence: 99%

Ultrahypofractionation in postoperative radiotherapy for breast cancer: A single‐institution retrospective cohort series

Calvo Tudela,

García Anaya,

Segado Guillot

et al. 2024

Cancer Medicine

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BackgroundThe ‘FAST‐forward’, study published in April 2020, demonstrated the effectiveness of an extremely hypofractionated radiotherapy schedule, delivering the total radiation dose in five sessions over the course of 1 week. We share our department's experience regarding patients treated with this regimen in real‐world clinical settings, detailing outcomes related to short‐term toxicity and efficacy.MethodsA descriptive observational study was conducted on 160 patients diagnosed with breast cancer. Between July 2020 and December 2021, patients underwent conservative surgery followed by a regimen of 26 Gy administered in five daily fractions.ResultsThe median age was 64 years (range: 43–83), with 82 patients (51.3%) treated for left‐sided breast cancer, 77 patients (48.1%) for right‐sided breast cancer, and 1 instance (0.6%) of bilateral breast cancer. Of these, 66 patients had pT1c (41.3%), 70.6% were infiltrative ductal carcinomas, and 11.3% were ductal carcinoma in situ. Most tumours exhibited intermediate grade (41.9%), were hormone receptor positive (81.3%), had low Ki‐67 (Ki‐67 < 20%; 51.9%) and were Her 2 negative (85%). The majority of surgical margins were negative (99.4%). Among the patients, 72.5% received hormonotherapy, and 23.8% received chemotherapy. Additionally, 26 patients (16.3%) received an additional tumour boost following whole breast irradiation (WHBI) of 10 Gy administered in five sessions of 2 Gy over a week. The median planning target volume (PTV) was 899 cm3 (range: 110–2509 cm3). Early toxicity was primarily grade I radiodermatitis, affecting 117 patients (73.1%). During a median follow‐up of 15 months (range: 3.9–28.77), only one patient experienced a local relapse, which required mastectomy.ConclusionsThe implementation of this highly hypofractionated regimen in early‐stage breast cancer appears feasible and demonstrates minimal early toxicity. However, a more extended follow‐up duration would be required to evaluate long‐term toxicity and efficacy accurately.

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“…A survey with responses from 45 Senology International Society members across 24 countries (0 in the UK) in June and July 2020 reported that 29% of participants reported that radiotherapy protocols were modified to reduce hospital stays (using HFRT), although it was not clear whether this was to moderate or ultra-HFRT [29]. Results from studies in the USA have also reported variable uptake of ultra-HRFT [30,31].…”

Section: Discussionmentioning

confidence: 99%

Change in the use of fractionation in radiotherapy used for early breast cancer at the start of the COVID-19 pandemic: A population-based cohort study of older women in England and Wales

Gannon

Miller

Horgan

et al. 2022

European Journal of Surgical Oncology

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Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer

Cited by 9 publications

References 26 publications

Implementation of External Beam Five-Fraction Adjuvant Breast Irradiation in a US Center

Implementation of External Beam Five-Fraction Adjuvant Breast Irradiation in a US Center

Ultrahypofractionation in postoperative radiotherapy for breast cancer: A single‐institution retrospective cohort series

Change in the use of fractionation in radiotherapy used for early breast cancer at the start of the COVID-19 pandemic: A population-based cohort study of older women in England and Wales

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