Fractionation for whole breast irradiation: An American Society for Radiation Oncology (ASTRO) evidence-based guideline (2011)
Authors: Benjamin D. Smith, MD, Søren M. Bentzen, PhD, DSc, Candace R.
Correa, MD, Carol A. Hahn, MD, Patricia
H. Hardenbergh, MD, Geoffrey S. Ibbott, PhD, Beryl McCormick, MD, FACR, Julie
R. McQueen, CHES, RHEd, Lori J. Pierce, MD, Simon N. Powell, MD, PhD, Abram
Recht, MD, Alphonse G. Taghian, MD, PhD, Frank A. Vicini, MD, FACR, Julia R.
White, MD, and Bruce G. Haffty, MD
This guideline provides guidance
for patients and physicians regarding the appropriate use of hypofractionated
whole breast irradiation (HF-WBI) as adjuvant treatment of breast cancer
following breast conserving surgery. The
clinical radiobiology of breast cancer is also explored. This paper investigates the literature
regarding which patients obtain equivalent results from HF-WBI and
conventionally fractionated whole breast irradiation (CF-WBI); the role of
a tumor bed radiation boost in HF-WBI patients; appropriate regimens for
HF-WBI and tumor bed boost; characteristics of an acceptable radiotherapy
plan for HF-WBI patients; and breast cancer radiobiology insights from
clinical trials comparing CF-WBI and HF-WBI. Data was sufficient to support the use of HF-WBI for early stage breast
cancer patients age 50 years or older, who had disease stage pT1-2 pN0, did not
receive chemotherapy and were treated with a radiation dose homogeneity within
±7 percent in the central axis plane. Data was considered insufficient to make a
judgment on the use of HF-WBI in other types of patients.
Read the guideline.