Don’t initiate whole breast radiotherapy in 25 fractions as a part of breast conservation therapy in women age ≥50 with early stage invasive breast cancer without considering shorter treatment schedules.

Whole breast radiotherapy is beneficial for most women with invasive breast cancer treated with breast conservation therapy. Many studies have utilized “conventionally fractionated” schedules that deliver therapy over 5 to 6 weeks, often followed by 1 to 2 weeks of boost therapy. However, more recent evidence (including a major study from Canada) has demonstrated equivalent tumour control and cosmetic outcome in specific patient populations with shorter courses of therapy (approximately 3 to 4 weeks). Patients and their physicians should review these options to determine the most appropriate course of therapy.

 

Sources:

Clarke M, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005 Dec 17;366(9503):2087-106. PMID: 16360786.

Darby S, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011 Nov 12;378(9804):1707-16. PMID: 22019144.

Smith BD, et al. Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011 Sep 1;81(1):59-68. PMID: 20638191.

Whelan TJ, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010 Feb 11;362(6):513-20. PMID: 20147717.