B E doubleD.

Top Line: We have tons of data supporting the safety and efficacy of hypofractionated whole breast radiation, but apparently we need more.
The Study: Despite 10-year follow-up from 4 randomized trials supporting its use, the uptake has been slow. The slow and steady wins the race camp primarily cite cosmetic concerns surrounding a lack of data with boosts, chemo, or larger breasts. So this phase 3 non-inferiority trial was designed specifically for all the tortoises out there. It randomized 247 women with stage I-II breast cancer to receive conventional (50 Gy / 25) versus hypofractionated (42.56 / 16) adjuvant whole breast radiation. Importantly all were followed by tumor bed boosts mostly of 10 Gy / 5 and 10 Gy / 4, respectively. Also pertinent is that almost one-third received chemo and over one-third had ≥ D-cup breasts. The primary endpoint was “adverse” patient-reported cosmesis at 3 years, defined as ≥ 2.5 on a scale from 1 to 4 (1 = no and 4 = large difference) when comparing the treated to the untreated breast. Tortoises better dust off their running shoes: the rate of adverse cosmesis was almost double with the conventional (14%) versus hypofractionated (8%) regimen. Who did best with an accelerated course? Those with at least D-cups, who enjoyed an 18% absolute advantage in rate of adverse cosmesis with hypofractionation. Beyond the obvious, this trial suggests that estimations of clinical outcomes based on breast BED are BAD.
Bottom Line: Hypofractionated whole breast radiation is a faster, effective way to prevent breast cancer recurrences AND it has women feeling good when they look in the mirror. | Shaitelman, J Clin Oncol 2018 & Recht, Int J Radiat Oncol Biol Phys 2018


  1. The information you have provided is very helpful at all thank you very much for sharing useful information with us. It is so nice to read about another woman going through it too!
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