Hypofractionation in carcinoma breast

1. HYPOFRACTIONATION IN CARCINOMA
BREAST
Dr. ADITYA SINGLA

2. WHAT IS HYPOFARCTIONATION
• Large doses of radiation per treatment fraction delivering a
full course of treatment over a shorter period of time
compared to conventional fractionation.
• 2.25 - ˃ 20 GY per day

3. RADIOBIOLOGY

4. TRIALS
• RMH/GOC
• CANADIAN
• SPOONER
• START A
• START B

5. ROYAL MARSDEN HOSPITAL/GLOUCESTER ONCOLOGY
CENTRE TRIAL
• PUBLISHED IN 2012
• 1410 patients(T1-3,N0-1,MO) treated with BCS
50GY/25#/5WK 39GY/13#/5WK 42.9GY/13#/5WK
LR at 10 years 12.1% 14.8% 9.6%
BED 83.3GY 78GY 90GY
D/F 2GY 3GY 3.3GY
CHANGES IN
BREAST AFTER
10YR
5.6% 3.4% 10.1%

6. CANADIAN TRIAL
• BCS patients with axillary negative node
N Engl J Med 2010;362:513-20.
Copyright © 2010 Massachusetts Medical Society.
50GY/25#/5wk 42.5GY/16#/22day
s
N 612 622
10yr LR 6.7% 6.2%
BED 83.3 79.9
D/F 2GY 2.65
GOOD COSMETIC
OUTCOME AT 10YR
71.3% 69.8%

7. START A TRIAL
Lancet Oncol. 2008 April 1; 9(4): 331–341.
• 2236 patients with pT1-3, PN0-1, M0, Post BCS/Mastectomy
•
50GY/25#/5WK 41.6GY/13#/5WK 39GY/13#/5WK
BED 83.3GY 85.6 78GY
D/F 2GY 3.2GY 3GY
LOCOREGIONAL
RELAPSE 5YR
3.6% 3.5% 5.2%

8. START B
• 2215 patients with pT1-3, PN0-1, M0, Post BCS/Mastectomy
50GY/25#/5WK 40/15#/3WK
BED 83.3GY 74.4GY
D/F 2GY 2.6GY
5YR locoregional
relapse
3.3% 2.2%

9. APBI
• 34GY/10#/5DAYS BD OR 20-22GY/#
• AGE ˃ 45/50 years
• Tumor upto 3 cm
• Node negative patients

10. INDICATIONS OF
HYPOFRACTIONATION
• Age ˃ 50 years
• T1-2,N0 with BCT
• Not treated with chemotherapy