Fractionation for whole breast irradiation: An American society for radiation oncology (ASTRO) evidence-based guideline Journal Article
| Authors: | Smith, B. D.; Bentzen, S. M.; Correa, C. R.; Hahn, C. A.; Hardenbergh, P. H.; Ibbott, G. S.; McCormick, B.; McQueen, J. R.; Pierce, L. J.; Powell, S. N.; Recht, A.; Taghian, A. G.; Vicini, F. A.; White, J. R.; Haffty, B. G. |
| Article Title: | Fractionation for whole breast irradiation: An American society for radiation oncology (ASTRO) evidence-based guideline |
| Abstract: | 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. Copyright © 2011 Elsevier Inc. |
| Keywords: | cancer chemotherapy; review; cancer patient; radiation dose; chemotherapy; cancer staging; antineoplastic agent; evidence based medicine; breast cancer; radiation; radiotherapy; patient monitoring; practice guideline; radiation injury; oncology; late effects; age; cancer hormone therapy; disease severity; radiation oncology; systematic review; radiation dose fractionation; irradiation; patient safety; medical society; tamoxifen; clinical effectiveness; local control; taxane derivative; anthracycline derivative; radiation dose distribution; randomized trial; hypofractionation; diseases; breast conserving surgery; breast-conserving therapy; randomized controlled trial (topic); breast conserving therapy; study design; primary treatment; tumor bed; evidence-based guideline; cardiac functions; central axis; clinical practices; early-stage breast cancer; systematic literature review; task force; whole-breast irradiation; whole breast irradiation |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 81 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2011-09-01 |
| Start Page: | 59 |
| End Page: | 68 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2010.04.042 |
| PROVIDER: | scopus |
| PUBMED: | 20638191 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 3 October 2011" - "CODEN: IOBPD" - "Source: Scopus" |
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