Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-10T19:19:31.421Z Has data issue: false hasContentIssue false
  • English
  • Français

A review on radiotherapy hypofractionation schedules for breast cancer treatment

Published online by Cambridge University Press:  23 November 2010

Christina Armpilia ,
Christos Antypas ,
Anna Zygogianni ,
Myrsini Balafouta ,
Panagiotis Sandilos  and
John Kouvaris
Christina Armpilia*
Affiliation:
Department of Radiotherapy, Aretaieion Hospital, Medical School, University of Athens, 76 Vas Sophias av., 11528, Athens, Greece
Christos Antypas
Affiliation:
Department of Radiotherapy, Aretaieion Hospital, Medical School, University of Athens, 76 Vas Sophias av., 11528, Athens, Greece
Anna Zygogianni
Affiliation:
Department of Radiotherapy, Aretaieion Hospital, Medical School, University of Athens, 76 Vas Sophias av., 11528, Athens, Greece
Myrsini Balafouta
Affiliation:
Department of Radiotherapy, Aretaieion Hospital, Medical School, University of Athens, 76 Vas Sophias av., 11528, Athens, Greece
Panagiotis Sandilos
Affiliation:
Department of Radiotherapy, Aretaieion Hospital, Medical School, University of Athens, 76 Vas Sophias av., 11528, Athens, Greece
John Kouvaris
Affiliation:
Department of Radiotherapy, Aretaieion Hospital, Medical School, University of Athens, 76 Vas Sophias av., 11528, Athens, Greece
*
Correspondence to: Christina Armpilia, Aretaieion Hospital, Medical School, University of Athens, 76 Vas Sophias av., 11528, Athens, Greece. E-mail: charbilia@med.uoa.gr
Get access Rights & Permissions [Opens in a new window]

Abstract

Radiation therapy is an integral part of management in breast carcinoma treatment. Standard curative schedules of radiotherapy to the breast deliver 25 fractions of 2.0 Gy per day over 5–6 weeks. Considerable recent literature suggests that hypo-fractionation may be advisory in breast cancer. The use of fewer fractions of more than 2 Gy per day (hypo-fractionation) is based on data suggesting that breast carcinoma is more sensitive to fraction size than squamous carcinomas and therefore could have similar fractionation sensitivity to the dose-limiting healthy tissues, including skin, subcutaneous tissues, muscle and ribs. In this article, a review of published studies and currently ongoing trials, which may provide evidence for the use of hypo-fractionated radiotherapy in breast cancer patients, is presented. Also, for all these different hypo-fractionation regimens found in literature, biologically effective dose (BED) values are calculated and compared. Data from studies and randomised trials seem to support the concept that modest hypo-fractionation can be used to treat the whole breast after breast-conserving surgery with similar rates of local control and radiation morbidity as seen with conventional fractionation.

Keywords

breast cancer radiotherapyhypo-fractionationbreast radiobiology
Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 10 , Issue 3 , September 2011 , pp. 201 - 208
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jacobson, JA, Danforth, DN, Cowan, KH, d'Angelo, T, Steinberg, SM, Pierce, L, Lippman, ME, Lichter, AS, Glatstein, E, Okunieff, P. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 1995; 332:907–911.CrossRefGoogle Scholar
Arriagada, R, Lê, MG, Rochard, F, Contesso, G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996; 14:1558–1564.CrossRefGoogle ScholarPubMed
Clark, RM, Whelan, T, Levine, M, Roberts, R, Willan, A, McCulloch, P, Lipa, M, Wilkinson, RH, Mahoney, LJ. Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology Group. J Natl Cancer Inst 1996; 88:1659–1664.CrossRefGoogle ScholarPubMed
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Favorable and unfavorable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomized trials. Lancet 2000; 355:1757–1770Google Scholar
van Dongen, JA, Voogd, AC, Fentiman, IS, Legrand, C, Sylvester, RJ, Tong, D, van der Schueren, E, Helle, PA, van Zijl, K, Bartelink, H. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000; 92:1143–1150.CrossRefGoogle ScholarPubMed
Fisher, B, Anderson, S, Briant, J et al. Twenty years follow-up of a randomized trial comparing total mastectomy, lumphectomy, and lumphectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 64:281–290.Google Scholar
Veronesi, U, Cascinelli, N, Mariani, L, Greco, M, Saccozzi, R, Luini, A, Aguilar, M, Marubini, E. Twenty-year follow-up of a randomized study comparing breast- conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347:1227–1232.CrossRefGoogle ScholarPubMed
Whelan, T, MacKenzie, R, Julian, J, Levine, M, Shelley, W, Grimard, L, Lada, B, Lukka, H, Perera, F, Fyles, A, Laukkanen, E, Gulavita, S, Benk, V, Szechtman, B. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst 2002; 94:1143–1150.CrossRefGoogle ScholarPubMed
Yarnold, J, Ashton, A, Bliss, J, Homewood, J, Harper, C, Hanson, J, Haviland, J, Bentzen, S, Owen, R. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol 2005; 75:9–17.CrossRefGoogle ScholarPubMed
Owen, JR, Ashton, A, Bliss, JM, Homewood, J, Harper, C, Hanson, J, Haviland, J, Bentzen, SM, Yarnold, JR. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol 2006; 7:467–471.CrossRefGoogle ScholarPubMed
The START ‘Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008; 29:1098–1107.Google Scholar
The START ‘Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008; 9:331–341.CrossRefGoogle Scholar
Barendsen, GW. Dose fractionation, dose rate and iso-effect relationships for normal tissue responses. Int J Radiat Oncol Biol Phys 1982; 8:1981–1997.CrossRefGoogle ScholarPubMed
Rosenstein, BS, Lymberis, SC, Formenti, SC. Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol Biol Phys 2004; 60:1393–1404.CrossRefGoogle ScholarPubMed
Williams, MV, Denekamp, J, Fowler, JF. A review of alpha/beta ratios for experimental tumors: implications for clinical studies of altered fractionation. Int J Radiat Oncol Biol Phys 1985; 11:87–96.CrossRefGoogle ScholarPubMed
Yamada, Y, Ackerman, I, Franssen, E, MacKenzie, RG, Thomas, G. Does the dose fractionation schedule influence local control of adjuvant radiotherapy for early stage breast cancer? Int J Radiat Oncol Biol Phys 1999; 44:99–104.CrossRefGoogle ScholarPubMed
Jones, B, Dale, RG, Deehan, C, Hopkins, KI, Morgan, DA. The role of biologically effective dose (BED) in clinical oncology. Clin Oncol (R Coll Radiol) 2001; 13:71–81.Google ScholarPubMed
Douglas, BG. Implications of the quadratic cell survival curve and human skin radiation “tolerance doses” on fractionation and superfractionation dose selection. Int J Radiat Oncol Biol Phys 1982; 8:1135–1142.CrossRefGoogle ScholarPubMed
Olivotto, IA, Weir, LM, Kim-Sing, C, Bajdik, CD, Trevisan, CH, Doll, CM, Lam, WY, Basco, VE, Jackson, SM. Late cosmetic results of short fractionation for breast conservation. Radiother Oncol 1996; 41:7–13.CrossRefGoogle ScholarPubMed
Shelley, W, Brundage, M, Hayter, C, Paszat, L, Zhou, S, Mackillop, W. A shorter fractionation schedule for postlumpectomy breast cancer patients. Int J Radiat Oncol Biol Phys 2000; 47:1219–1228.CrossRefGoogle ScholarPubMed
Fujii, O, Hiratsuka, J, Nagase, N, Tokiya, R, Yoden, E, Sonoo, H, Murashima, N, Iha, S, Imajyo, Y. Whole-breast radiotherapy with shorter fractionation schedules following breast-conserving surgery: short-term morbidity and preliminary outcomes. Breast Cancer 2008; 15:86–92.CrossRefGoogle ScholarPubMed
Livi, L, Stefanacci, M, Scoccianti, S, Dicosmo, D, Borghesi, S, Nosi, F, Simontacchi, G, Mangoni, M, Paiar, F, Ponticelli, P, Nori, J, Chiavacci, A, Biti, GP. Adjuvant hypofractionated radiation therapy for breast cancer after conserving surgery. Clin Oncol (R Coll Radiol) 2007; 19:120–124.CrossRefGoogle ScholarPubMed
Haustermans, K, Fowler, J, Geboes, K, Christiaens, MR, Lerut, A, van der Schueren, E. Relationship between potential doubling time (Tpot), labeling index and duration of DNA synthesis in 60 esophageal and 35 breast tumors: Is it worthwhile to measure Tpot? Radiother Oncol 1998; 46:157–167.CrossRefGoogle ScholarPubMed
Thames, HD, Bentzen, SM, Turesson, I, Overgaard, M, Van den Bogaert, W. Time-dose factors in radiotherapy: a review of the human data. Radiother Oncol 1990; 19:219–235.CrossRefGoogle ScholarPubMed
Turesson, I, Thames, HD. Repair capacity and kinetics of human skin during fractionated radiotherapy: erythema, desquamation, and telangiectasia after 3 and 5 year’s follow-up. Radiother Oncol 1989; 15:169–188.CrossRefGoogle ScholarPubMed
Archambeau, JO, Pezner, R, Wasserman, T. Pathophysiology of irradiated skin and breast. Int J Radiat Oncol Biol Phys 1995; 31:1171–1185.CrossRefGoogle ScholarPubMed
Kurtz, JM. The clinical radiobiology of breast cancer radiotherapy. Radiother Oncol 2005; 75:6–8.CrossRefGoogle ScholarPubMed
Yarnold, J, Bloomeld, D, LeVay, J. Prospective randomized trial testing 5.7 Gy and 6.0 Gy fractions of whole breast radiotherapy in women with early breast cancer (FAST) trial. Clin Oncol 2004; 16:S30.Google Scholar
Freedman, GM, Anderson, PR, Goldstein, LJ, Ma, CM, Li, J, Swaby, RF, Litwin, S, Watkins-Bruner, D, Sigurdson, ER, Morrow, M. Four-week course of radiation for breast cancer using hypofractionated intensity modulated radiation therapy with an incorporated boost. Int J Radiat Oncol Biol Phys 2007; 68:347–353.CrossRefGoogle ScholarPubMed
Sørlie, T, Perou, CM, Tibshirani, R, Aas, T, Geisler, S, Johnsen, H, Hastie, T, Eisen, MB, van de Rijn, M, Jeffrey, SS, Thorsen, T, Quist, H, Matese, JC, Brown, PO, Botstein, D, Eystein Lønning, P, Børresen-Dale, AL. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 2001; 98:10869–10874.CrossRefGoogle ScholarPubMed