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Hypofractionation: The standard for external beam breast irradiation

Brunt, Adrian Murray; Haviland, Joanne Susan

Hypofractionation: The standard for external beam breast irradiation Thumbnail


Joanne Susan Haviland


This overview provides the historical perspective of external beam breast hypofractionation over the last 50 years. It highlights the serious harm suffered by patients with breast cancer in the 1970's and 1980's because of new hypofractionation regimens based on a theoretical radiobiology model being adopted into clinical practice to solve a resource issue without testing within clinical trials and without the essential radiotherapy quality assurance. It then describes the high-quality clinical trials comparing 3-week with 5-week standard of care regimens that were initiated based on a strong scientific rationale for hypofractionation in breast cancer. Today, there are still challenges with universal implementation of the results of these moderate hypofractionation studies, but there is now a substantial body of evidence to support 3-week breast radiotherapy with several large randomised trials still to report. The limit of breast hypofractionation is then explored and randomised trials investigating 1-week radiotherapy are described. This approach is now standard of care in many countries for whole or partial breast radiotherapy and chest wall radiotherapy without immediate reconstruction. It also has the advantage of reducing burden of treatment for patients and providing cost-effective care. Further research is needed to establish the safety and efficacy of 1-week breast locoregional radiotherapy and following immediate breast reconstruction. In addition, clinical studies are required to determine how a tumour bed boost for patients with breast cancer at higher risk of relapse can be incorporated simultaneously into a 1-week radiotherapy schedule. As such, the breast hypofractionation story is still unfolding.

Journal Article Type Article
Acceptance Date Apr 23, 2023
Online Publication Date Apr 24, 2023
Publication Date 2023-06
Publicly Available Date May 30, 2023
Journal The Breast
Print ISSN 0960-9776
Electronic ISSN 0960-9776
Publisher Elsevier
Volume 69
Pages 410 - 416
Publisher URL