👉Hypofractionated WBI continues to increase in utilization based on data from the Ontario Oncology trial as well as 5- and 10-year data from the UK Standardisation of Breast Radiotherapy (START) A and B trials.
👉Standardized treatment schedules for hypofractionation typically are 15 to 16 fractions over 3 to 4 weeks depending on inclusion of a boost.
👉The risk of local recurrence in the Ontario Oncology Trial at 10 years was 6.7% among the 612 women assigned to standard irradiation compared with 6.2% among the 622 women assigned to the hypofractionated regimen (absolute difference, 0.5 percentage points; 95% confidence interval [CI], −2.5 to 3.5).
👉At 10 years, 71.3% of women in the control group compared with 69.8% of the women in the hypofractionated radiation group had a good or excellent cosmetic outcome (absolute difference, 1.5 percentage points; 95% CI, −6.9 to 9.8).
👉In the START-B trial, the proportion of patients with local-regional relapse at 10 years did not differ significantly between the 40 Gy (hypofractionation) group (4.3%, 95% CI, 3.2–5.9) and the 50 Gy (standard) group (5.5%, 95% CI, 4.2–7.2; hazard ratio, 0.77, 95% CI, 0.51–1.6; P=0.21).
👉There was less breast shrinkage, telangiectasia, and edema in the 40 Gy/15 fraction arm.
👉 Traditionally, a separation (the distance from the medial to the lateral border of the tangential beam) of 25 cm was utilized as a cut off, but now a maximum dose of 107% of prescription is used in light of advancements in planning techniques.
👉Current evidence-based American Society for Radiation Oncology (ASTRO) guidelines on fractionation recommend hypofractionated WBI be considered in patients age 50 years and older with T1-T2N0 disease who do not receive chemotherapy.
👉It should be noted that the percentage of patients with nodal positivity in these trials was quite low, so the role of hypofractionated regimens in node-positive patients remains unanswered.
- Rodrigo Arrangoiz MS, MD, FACS cirujano de mama / cirujano oncology miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
- Es experto en el manejo del cáncer de mama.
Training:
• General surgery:
• Michigan State University:
• 2004 al 2010
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• Fox Chase Cancer Center (Filadelfia):
• 2010 al 2012
• Masters in Science (Clinical research for health professionals):
• Drexel University (Filadelfia):
• 2010 al 2012
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:
• IFHNOS / Memorial Sloan Kettering Cancer Center:
• 2014 al 2016
Rodrigo Arrangoiz MS, MD, FACS, FSSO 