Fractionation for Whole Breast Irradiation: An American Society for Radiation Oncology (ASTRO) Evidence-Based Guideline

Journal Article · Thu Sep 01 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.04.042· OSTI ID:21587697

Bentzen, Soren M ^[1]; Correa, Candace R ^[2]; Hahn, Carol A ^[3]; Hardenbergh, Patricia H ^[4]; Ibbott, Geoffrey S ^[5]; McCormick, Beryl ^[6]; McQueen, Julie R ^[7]; Pierce, Lori J ^[2]; Powell, Simon N ^[6]; Recht, Abram ^[8]; Taghian, Alphonse G ^[9]; Vicini, Frank A ^[10]; White, Julia R ^[11]; Haffty, Bruce G ^[12]

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1. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI (United States)
2. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)
3. Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)
4. Shaw Regional Cancer Center, Vail, CO (United States)
5. Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)
6. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY (United States)
7. Oncology Patient Navigator, Duke Raleigh Cancer Center, Durham, NC (United States)
8. Department of Radiation Oncology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA (Israel)
9. Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
10. Department of Radiation Oncology, Beaumont Cancer Institute, Royal Oak, MI (United States)
11. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)
12. Department of Radiation Oncology, Cancer Institute of New Jersey, New Brunswick, NJ (United States)

Purpose: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. Methods and Materials: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. Results: The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within {+-}7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI. Conclusion: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.

• OSTI ID: 21587697
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 81; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BODY
CARDIOVASCULAR SYSTEM
CHEMOTHERAPY
DISEASES
DOSES
FRACTIONATION
GLANDS
HEART
IRRADIATION
MAMMARY GLANDS
MEDICINE
NEOPLASMS
ORGANS
RADIATION DOSES
RECOMMENDATIONS
SEPARATION PROCESSES
SURGERY
THERAPY