Fractionation for whole breast irradiation: An American society for radiation oncology (ASTRO) evidence-based guideline

Benjamin D. Smith, Soren M. Bentzen, Candace R. Correa, Carol A. Hahn, Patricia H. Hardenbergh, Geoffrey S. Ibbott, Beryl McCormick, Julie R. McQueen, Lori J. Pierce, Simon N. Powell, Abram Recht, Alphonse G. Taghian, Frank A. Vicini, Julia R. White, Bruce G. Haffty

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344 Scopus citations


Purpose: In patients with early-stage breast cancer treated with breast-conserving surgery, randomized trials have found little difference in local control and survival outcomes between patients treated with conventionally fractionated (CF-) whole breast irradiation (WBI) and those receiving hypofractionated (HF)-WBI. However, it remains controversial whether these results apply to all subgroups of patients. We therefore developed an evidence-based guideline to provide direction for clinical practice. Methods and Materials: A task force authorized by the American Society for Radiation Oncology weighed evidence from a systematic literature review and produced the recommendations contained herein. Results: The majority of patients in randomized trials were aged 50 years or older, had disease Stage pT1-2 pN0, did not receive chemotherapy, and were treated with a radiation dose homogeneity within ±7% in the central axis plane. Such patients experienced equivalent outcomes with either HF-WBI or CF-WBI. Patients not meeting these criteria were relatively underrepresented, and few of the trials reported subgroup analyses. For patients not receiving a radiation boost, the task force favored a dose schedule of 42.5 Gy in 16 fractions when HF-WBI is planned. The task force also recommended that the heart should be excluded from the primary treatment fields (when HF-WBI is used) due to lingering uncertainty regarding late effects of HF-WBI on cardiac function. The task force could not agree on the appropriateness of a tumor bed boost in patients treated with HF-WBI. Conclusion: Data were sufficient to support the use of HF-WBI for patients with early-stage breast cancer who met all the aforementioned criteria. For other patients, the task force could not reach agreement either for or against the use of HF-WBI, which nevertheless should not be interpreted as a contraindication to its use.

Original languageEnglish (US)
Pages (from-to)59-68
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number1
StatePublished - Sep 1 2011

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


  • Breast cancer
  • Breast conserving therapy
  • Evidence-based guideline
  • Hypofractionation


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