Breast Cancer

Ultrahypofractionation in Early-Stage Breast Cancer

The July 2022 #RadOnc #JC will focus on ultrahypofractionation in early-stage breast cancer.

The July 16th-17th Journal Club will begin Saturday, July 16th at 8am CST and go through Sunday, July 17th, culminating in the Live Hour from 1-2pm CST on Sunday, July 17th on Twitter Spaces.

The ideal fractionation for early-stage breast cancer patients has been the subject of trials over the past several decades. Historically, these patients were treated with a 25-28 fraction radiation course, however hypofractionation with 15-16 fractions was adopted as a new standard after completion of randomized trials within the UK (1) and Canada (2). Seeking further hypofractionation, FAST (3) and FAST-FORWARD (4) provided a backbone for the use of five fraction regimens to 28.5 or 26 Gy, respectively

New fractionation regimens often trickle into daily practice over time, but the COVID-19 pandemic strained healthcare resources and caused many to seek opportunities to limit exposures to hospitals and clinics, posing a unique opportunity for early-adoption of ultrahypofractionation in early-stage breast cancer. In this month’s #RadOnc #JC, we will discuss “Adoption of Ultrahypofractionated Radiation Therapy in Patients with Breast Cancer.” This article highlights the selective adaptation of this treatment regimen at a single center.

Corrigan, Kelsey L et al. “Adoption of Ultrahypofractionated Radiation Therapy in Patients With Breast Cancer.” Advances in Radiation Oncology vol. 7,2 100877. 24 Dec. 2021, doi:10.1016/j.adro.2021.100877

We will be joined by first author, Dr. Kelsey Corrigan (@kelseycorrigan), and several guests including Drs. Melissa Mitchell (@MMitchellMDPhD), Chirag Shah (@CShahMD), and Adam Currey (@ACurreyMD), and others.

Our guiding topics this month are as follows:

T1. Background: What data supports the use of hypofractionated regiments in early-stage breast cancers? How have these fractionation regimens evolved over time?

T2. Methods: What methodology was utilized in this study? What patients were reviewed? What are the strengths and weaknesses of this methodology?

T3. Results/Discussion: What patient and physician-level factors predicted for the use of ultrahypofractionated radiation? Who are ideal candidates to adapt this fractionation for? What is the current role for ultrahypofractionated radiation in early-stage breast cancer? What will help increase the use of this fractionation within this patient cohort? How do external factors, such as the COVID-19 pandemic, impact clinical decision-making?

T4: #PatientsIncluded:  What is important for breast cancer patients for shared decision-making for treatment?

T5. Conclusion/Next Steps: How do you see radiation for early-stage breast cancer changing in the coming years? How do we take our experiences during COVID-19 and use them to frame our decisions in the future as we move into a new phase of the pandemic?

Some tips to participate:

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References

1.         Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bentzen SM, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;371(9618):1098-107.

2.         Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513-20.

3.         Brunt AM, Haviland JS, Sydenham M, Agrawal RK, Algurafi H, Alhasso A, et al. Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer. J Clin Oncol. 2020;38(28):3261-72.

4.         Murray Brunt A, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395(10237):1613-26.

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