Hypofractionated Breast Irradiation: What’s Next?
Mené sur 915 patientes atteintes d'un carcinome mammaire invasif à faible risque de récidive (âge : 50 ans ou plus), cet essai multicentrique randomisé évalue les effets à long terme d'une radiothérapie hypofractionnée de l'ensemble du sein (5 fractions) sur l'évolution de l'apparence photographique du sein, les tissus normaux et le contrôle local de la tumeur
It has been more than 30 years since the pioneering trials that established the important role of whole-breast irradiation (WBI) after breast-conserving surgery (BCS) in decreasing local recurrence and thereby avoiding mastectomy.1-3 The initial trials used conventional fractionation of 50 Gy given in 25 fractions of 2 Gy once a day over 5 weeks. This regimen can be inconvenient and costly for patients and may limit access to radiotherapy (RT) after BCS.4,5 In response, hypofractionated RT regimens in which a larger dose per fraction given in a smaller number of fractions often over a shorter time period were evaluated. Modest hypofractionated RT, eg, 40-42.5 Gy given in 15-16 fractions of 2.7 Gy over 3 to 3.5 weeks was shown to have similar rates of local recurrence, late normal tissue toxicity, and breast cosmesis at 10 years compared with conventional fractionation over 5 weeks.6,7 Hypofractionated RT has become a standard after BCS.8 However, 3 weeks of treatment is still inconvenient for some patients, and other approaches, including accelerated partial breast irradiation often given in a week or less or no RT in low-risk patients, have been evaluated.