Systematic review and meta-analysis comparing hypofractionated with conventional fraction radiotherapy in treatment of early breast cancer

Zhou, Zhirui; Xin, Mei; Chen, Xing‐Xing; Yang, Zhaozhi; Hou, Jing; Zhang, Li; Yu, Xiaoli; Guo, Xiaomao

doi:10.1016/j.suronc.2015.06.005

Cited by 31 publications

(36 citation statements)

References 35 publications

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“…There was no significant difference in the DFS between the conventional arm and the hypofractionation arm (p = 0.6). This is consistent with the results of a meta-analysis of 4 studies (including START A, B and Canadian trial) [16][17][18] that included 5261 patients revealing no significant difference in DFS between the two fractionation schedules (p = 0.53) 9 .…”

Section: Conventional Hypofractionationsupporting

confidence: 88%

“…Routine utilization of hypofractionated radiotherapy is evidenced by the results of five main randomized controlled trials in patients with early breast cancer, demonstrating that hypofractionated radiotherapy has comparable or better outcomes in all main end points; effectiveness, toxicity, cosmetic outcome and cost effectiveness 6,7,[9][10][11] . The latest American Society for Radiation Oncology (ASTRO) clinical guideline for the adjuvant whole breast radiotherapy recommends a hypofractionated whole breast irradiation regimen (4000 cGy in 15 fractions or 4250 cGy in 16 fractions) 12 .…”

Section: Introductionmentioning

confidence: 99%

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Randomized Prospective Study Comparing Conventional Versus Hypofractionated Adjuvant Radiotherapy in Node-Positive Breast Cancer

Atef

Sheikh

Ellithy

et al. 2019

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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Background: Hypofractionated radiotherapy in early breast cancer yields equivalent or better outcome in terms of efficacy, toxicity, cosmesis and cost-effectiveness. However, its role in node-positive breast cancer is less clear. Aim: To compare between adjuvant conventional and hypofractionated radiotherapy in node-positive breast cancer. Methods: Prospective pilot study of 66 node-positive breast cancer patients recruited over 1 year in a single institution. Patients were randomized to receive adjuvant conventional radiotherapy 200 cGy x 25 fractions with 200 cGy x 5 fractions boost to the tumor bed in case of breast conservation (control arm) or hypofractionated radiotherapy 266 cGy x 16 fractions with 266 cGy x 4 fractions boost to the tumor bed in case of breast conservation (intervention arm). The end points were disease-free survival, cosmetic outcome, ipsilateral arm lymphedema and acute skin reactions. Results: Disease-free survival did not differ significantly between the two treatment arms (p = 0.6) and the 2-year diseasefree survival rate was 87% and 89% in the hypofractionated and conventional arms. The rate of excellent/good cosmetic score was higher in the hypofractionated arm than the conventional as rated by patients (71% vs. 46%, p = 0.182) and physicians (29% vs. 8%, p = 0.32). Hypofractionation, when compared to conventional fractionation, was associated with less arm lymphedema (22% vs. 40%, p = 0.149), dry desquamation (28% vs. 53%, p = 0.04), skin darkness (0% vs. 15%, p = 0.054) and wet desquamation (16% vs. 21%, p = 0.601). Conclusion: Hypofractionated adjuvant radiotherapy in node-positive breast cancer patients is equivalent to conventional fractionation as regards disease-free survival, cosmetic outcome and arm lymphedema with less early skin reactions.

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Section: Conventional Hypofractionationsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Randomized Prospective Study Comparing Conventional Versus Hypofractionated Adjuvant Radiotherapy in Node-Positive Breast Cancer

Atef

Sheikh

Ellithy

et al. 2019

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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“…In a systematic review based on these data, Zhou et al [8 ]suggested that HFRT with 2.5-3.0 Gy per fraction should be the better choice for the treatment of early BC patients. HFRT was associated with decreased grade 2/3 acute skin reactions and significantly decreased moderate/marked photographic changes in breast appearance compared to CFRT (relative risk (RR) 0.80, 95% confidence interval (CI) 0.70-0.91; p = 0.001).…”

Section: Hypofractionated Radiotherapymentioning

confidence: 99%

Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer

et al. 2018

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Radiation therapy (RT) for breast cancer has dramatically changed over the past years, leading to individualized risk-adapted treatment strategies. Historically, the choice of RT regimen was limited to conventional fractionation protocols using standard tangential fields. Nowadays, technological and technical improvements in modern RT have added a variety of other RT modalities, different fractionation schedules, and individualised treatment volumes to the portfolio of breast RT. This review aims to give a short overview on the main topics which have recently found their way into clinical practice: hypofractionated treatment protocols, accelerated partial breast irradiation (APBI) for low-risk patients, deep inspiration breath hold (DIBH) for maximal heart protection, extent of regional nodal irradiation for high-risk patients, and the implementation of new radiation techniques such as intensity modulated RT (IMRT) and volumetric modulated RT (VMAT).

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“…However, alternate fractionation, such as hypofractionation, could offer a shorter treatment course with a substantial increase in quality of life. Hypofractionation has been shown to be a valid alternative for early breast cancer radiation, with schedules decreasing from 33 to 15–16 and finally 5 fractions yielding similar results in well-selected patients (52–54). In this case, hypofractionation could cut the treatment duration by half and have a significant impact on quality of life and treatment cost (55).…”

Section: Clinical Implementationmentioning

confidence: 99%

Data-Based Radiation Oncology: Design of Clinical Trials in the Toxicity Biomarkers Era

et al. 2017

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The ability to stratify patients using a set of biomarkers, which predict that toxicity risk would allow for radiotherapy (RT) modulation and serve as a valuable tool for precision medicine and personalized RT. For patients presenting with tumors with a low risk of recurrence, modifying RT schedules to avoid toxicity would be clinically advantageous. Indeed, for the patient at low risk of developing radiation-associated toxicity, use of a hypofractionated protocol could be proposed leading to treatment time reduction and a cost–utility advantage. Conversely, for patients predicted to be at high risk for toxicity, either a more conformal form or a new technique of RT, or a multidisciplinary approach employing surgery could be included in the trial design to avoid or mitigate RT when the potential toxicity risk may be higher than the risk of disease recurrence. In addition, for patients at high risk of recurrence and low risk of toxicity, dose escalation, such as a greater boost dose, or irradiation field extensions could be considered to improve local control without severe toxicities, providing enhanced clinical benefit. In cases of high risk of toxicity, tumor control should be prioritized. In this review, toxicity biomarkers with sufficient evidence for clinical testing are presented. In addition, clinical trial designs and predictive models are described for different clinical situations.

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Systematic review and meta-analysis comparing hypofractionated with conventional fraction radiotherapy in treatment of early breast cancer

Cited by 31 publications

References 35 publications

Randomized Prospective Study Comparing Conventional Versus Hypofractionated Adjuvant Radiotherapy in Node-Positive Breast Cancer

Randomized Prospective Study Comparing Conventional Versus Hypofractionated Adjuvant Radiotherapy in Node-Positive Breast Cancer

Recent Developments in Radiation Oncology: An Overview of Individualised Treatment Strategies in Breast Cancer

Data-Based Radiation Oncology: Design of Clinical Trials in the Toxicity Biomarkers Era

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