Keywords
adjuvant radiotherapy
hypofractionation
ultra-hypofractionated radiotherapy
FAST-Forward
How to Cite
Abstract
Adjuvant breast radiotherapy has shifted from conventionally fractionated regimens (50 Gy in 25 fractions) to moderately hypofractionated schedules, with 40 Gy in 15 fractions widely adopted as a standard of care. Results of the FAST and FAST-Forward trials opened the way to ultra-hypofractionated regimens delivered in five fractions. The 26 Gy in 5 fractions schedule given over one week was shown to be non-inferior to 40 Gy in 15 fractions in terms of local control and late normal tissue effects, and is increasingly being implemented in routine practice. The aim of this review is to summarise the radiobiological rationale for the use of ultra-hypofractionated adjuvant breast radiotherapy with particular focus on the 26 Gy in 5 fractions regimen, and to present key clinical data from randomised and observational studies. Current guideline recommendations and patient selection criteria for five-fraction schedules are discussed. A separate section is devoted to practical aspects of treatment planning with three-dimensional conformal radiotherapy and volumetric modulated arc therapy, including heart and lung sparing and dose homogeneity within the breast or chest wall. Particular attention is paid to late toxicity, cosmetic outcomes and potential organisational and economic benefits of implementing ultra-hypofractionated breast radiotherapy in Polish radiotherapy departments.
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