• Timothy J Whelan, Jean-Philippe Pignol, Mark N Levine, Jim A Julian, Robert MacKenzie, Sameer Parpia, Wendy Shelley, Laval Grimard, Julie Bowen, Himu Lukka, Francisco Perera, Anthony Fyles, Ken Schneider, Sunil Gulavita, and Carolyn Freeman.
• McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada. tim.whelan@jcc.hhsc.ca
• N. Engl. J. Med. 2010 Feb 11; 362 (6): 513-20.

BackgroundThe optimal fractionation schedule for whole-breast irradiation after breast-conserving surgery is unknown.MethodsWe conducted a study to determine whether a hypofractionated 3-week schedule of whole-breast irradiation is as effective as a 5-week schedule. Women with invasive breast cancer who had undergone breast-conserving surgery and in whom resection margins were clear and axillary lymph nodes were negative were randomly assigned to receive whole-breast irradiation either at a standard dose of 50.0 Gy in 25 fractions over a period of 35 days (the control group) or at a dose of 42.5 Gy in 16 fractions over a period of 22 days (the hypofractionated-radiation group).ResultsThe risk of local recurrence at 10 years was 6.7% among the 612 women assigned to standard irradiation as compared with 6.2% among the 622 women assigned to the hypofractionated regimen (absolute difference, 0.5 percentage points; 95% confidence interval [CI], -2.5 to 3.5). At 10 years, 71.3% of women in the control group as compared with 69.8% of the women in the hypofractionated-radiation group had a good or excellent cosmetic outcome (absolute difference, 1.5 percentage points; 95% CI, -6.9 to 9.8).ConclusionsTen years after treatment, accelerated, hypofractionated whole-breast irradiation was not inferior to standard radiation treatment in women who had undergone breast-conserving surgery for invasive breast cancer with clear surgical margins and negative axillary nodes. (ClinicalTrials.gov number, NCT00156052.)2010 Massachusetts Medical Society

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