• Icro Meattini, Carlotta Becherini, Liesbeth Boersma, Orit Kaidar-Person, Gustavo Nader Marta, Angel Montero, Birgitte Vrou Offersen, Marianne C Aznar, Claus Belka, Adrian Murray Brunt, Samantha Dicuonzo, Pierfrancesco Franco, Mechthild Krause, Mairead MacKenzie, Tanja Marinko, Livia Marrazzo, Ivica Ratosa, Astrid Scholten, Elżbieta Senkus, Hilary Stobart, Philip Poortmans, and Charlotte E Coles.
• Department of Experimental and Clinical Biomedical Sciences M Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy. Electronic address: icro.meattini@unifi.it.
• Lancet Oncol. 2022 Jan 1; 23 (1): e21e31e21-e31.

AbstractHigh-quality randomised clinical trials testing moderately fractionated breast radiotherapy have clearly shown that local control and survival is at least as effective as with 2 Gy daily fractions with similar or reduced normal tissue toxicity. Fewer treatment visits are welcomed by patients and their families, and reduced fractions produce substantial savings for health-care systems. Implementation of hypofractionation, however, has moved at a slow pace. The oncology community have now reached an inflection point created by new evidence from the FAST-Forward five-fraction randomised trial and catalysed by the need for the global radiation oncology community to unite during the COVID-19 pandemic and rapidly rethink hypofractionation implementation. The aim of this paper is to support equity of access for all patients to receive evidence-based breast external beam radiotherapy and to facilitate the translation of new evidence into routine daily practice. The results from this European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus state that moderately hypofractionated radiotherapy can be offered to any patient for whole breast, chest wall (with or without reconstruction), and nodal volumes. Ultrafractionation (five fractions) can also be offered for non-nodal breast or chest wall (without reconstruction) radiotherapy either as standard of care or within a randomised trial or prospective cohort. The consensus is timely; not only is it a pragmatic framework for radiation oncologists, but it provides a measured proposal for the path forward to influence policy makers and empower patients to ensure equity of access to evidence-based radiotherapy.Copyright © 2022 Elsevier Ltd. All rights reserved.

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