For Patients with Breast Cancer, Which Postoperative Radiation Schedule Is Best?

Various radiation fractionation schedules exist in breast cancer treatment, and different clinical scenarios might make one approach more appropriate than another. Important considerations beyond efficacy are adverse effect profiles and cosmesis. To learn more about these effects in a meta-analysis, investigators searched all relevant, randomized, controlled, postsurgical studies worldwide to identify 35 clinical trials (>20,000 patients) evaluating different fractionation schedules: conventional fractionation (CF; daily dose, 1.8–2.0 Gy; typical total dose, 50.0–50.4 Gy, in 25–28 fractions over 5–6 weeks), moderate hypofractionation (MHF; daily dose, 2.65–3.30 Gy; 13–16 fractions over 3–5 weeks), or ultra-fractionation (UHF; 5 total fractions).

The risk for grade 2 or higher acute radiation dermatitis was significantly less with MHF than CF, both overall and separately in breast-conserving and post-mastectomy patient groups. This risk was not statistically different between MHF and UHF. Late effects of hyperpigmentation and shrinkage of the breast were also significantly less with MHF than CF but only overall and in the post-mastectomy group. Clinical endpoints of survival and recurrence were similar with CF, MHF, and UHF.