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Hypofractionation – whole breast irradiation

Adjusted α/β 4.6

Breast cancer is more sensitive to fraction size:

No advantage in using ≤ 2 Gy fractions

4 phase III studies whole breast irradiation:

Standard fractionation (25 x 2 Gy)

vs.

Hypofractionation

Canada: 16 x 2.66 Gy

UK: 15x 2.67 Gy / 13x 3, 3.2 or 3.3 Gy

n = 7,000 patients; median follow-up 10 years

Haviland Lancet Oncol 2013, Yarnold RO 2005, Whelan NEJM 2010,

START B Lancet 2008, START A Lancet Oncol 2008, Owen Lancet Oncol 2006