Hypofractionated Whole Breast Irradiation

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Hypofractionated WBI::
    • Continues to increase in its utilization, with several regimens available including the:
      • Canadian regimen (42.5 Gy / 16 fractions) and various United Kingdom (UK) regimens
    • Ten-year data are now available:
      • With a local recurrence rate of 7% from the Canadian regimen and no difference in local recurrence or toxicity compared with standard fractionation
    • Similar results have been seen with the UK Standardisation of Breast Radiotherapy (START) A and B trials:
      • Which have found no difference in local recurrence with fewer treatments and higher doses per treatment compared to standard fractionation
      • The START B trial:
        • Randomized 2,215 women to 40 Gy in 15 fractions, or standard 50 Gy in 25 fractions
        • The 10-year local-regional relapse rate was 4.3% for the 40 Gy group and 5.5% for the 50 Gy group
        • Breast shrinkage, telangiectasia, and breast edema were significantly less common in the hypofractionation group compared to the standard fractionation group
  • The patients treated with hypofractionation represent a diverse population:
    • Specifically, in the Canadian trials 24% of patients were younger than 50 years, 31% had tumors > 3 cm, 26% were ER–, 18% had high-grade tumors, 42% received tamoxifen, and 11% received adjuvant systemic therapy of cyclophosphamide, methotrexate, and fluorouracil as the standard chemotherapy
    • In the START A trial, 51% had tumors < 2 cm, but 29% had positive lymph nodes. Only 35% of patients in this trial received adjuvant systemic therapy
  • Collectively, the hypofractionation trials represent a more diverse, higher risk patient population in an era without the benefits of modern systemic therapy:
    • This may explain the relatively higher rates of local failure when compared to the accelerated partial breast irradiation group
  • References
    • Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513-520.
    • Haviland JS, Owen JR, Dewar JA, et al; START Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment early stage breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086-1094.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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