# Radiotherapy dose and fractionation by cancer site: UK reference schedules

Source: https://onco.cc/protocols/radiotherapy-dose-fractionation-reference/  
OnCo record `radiotherapy-dose-fractionation-reference` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiotherapy is given as a total dose split into a number of treatments (fractions). For most common cancers there is a standard schedule backed by trials: for example one week for early breast cancer, four weeks for prostate cancer, and often a single treatment for painful bone metastases. Fewer, larger treatments are now standard for many cancers because trials showed they work as well.

## Summary

The RCR's Radiotherapy dose fractionation (fourth edition, January 2024) is the UK reference: evidence-based schedules for 22 sites, each graded on the Oxford CEBM scale (A consistent level 1 studies to D expert opinion). It covers external beam only (brachytherapy is excluded), avoids recommending fields, volumes or technique, and states that inclusion does not mean a schedule is commissioned by the NHS in any of the four nations. It also sets out what a complete prescription contains.

Examples, as printed: adjuvant non-nodal breast or chest wall without immediate reconstruction 26 Gy in 5 fractions over 1 week (A), the same for external beam partial breast (A), regional nodes 40 Gy in 15 (B); prostate only 60 Gy in 20 fractions over 4 weeks (A); radical bladder 55 Gy in 20 (A); short-course preoperative rectal 25 Gy in 5 (A); medically inoperable peripheral T1 to T2b N0 lung SABR 54 Gy in 3 (B); glioblastoma with good performance status under 70, 60 Gy in 30 with or without temozolomide (A); painful bone metastases 8 Gy single dose (A); spinal cord compression in non-ambulant patients or a prognosis under 6 months 8 Gy single dose (A), and 20 Gy in 5 or 30 Gy in 10 for ambulant patients with a good prognosis or after surgery (B).

ASTRO differs in places: its 2018 whole-breast guideline prefers 40 Gy in 15 or 42.5 Gy in 16 (not 26 Gy in 5); its 2024 bone metastasis guideline lists 8 Gy in 1, 20 Gy in 5, 24 Gy in 6 or 30 Gy in 10 as equally recommended and conditionally prefers SBRT for selected patients with good performance status; its October 2026 prostate guideline recommends moderate hypofractionation over conventional fractionation for all risk groups and ultrahypofractionation as a standard option for low and intermediate risk.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: dose fractionation; RCR dose fractionation fourth edition; fractionation schedules; radiotherapy prescription; how many fractions; hypofractionation schedules; 26 Gy in 5 fractions; 60 Gy in 20 fractions; 8 Gy single fraction

## Connected records

- protocols: [Bladder filling and rectal preparation for prostate radiotherapy](https://onco.cc/protocols/prostate-radiotherapy-bladder-and-rectal-preparation/), [Breast radiotherapy positioning, immobilisation and daily set-up verification](https://onco.cc/protocols/breast-radiotherapy-positioning-and-setup/)
- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Rectal cancer](https://onco.cc/cancers/rectal-cancer/)
- technologies: [SBRT / SABR (stereotactic radiotherapy)](https://onco.cc/technologies/sbrt/)
- institutions: [American Society for Radiation Oncology](https://onco.cc/institutions/astro/)
- terms: [Bone metastases and skeletal-related events](https://onco.cc/terms/bone-metastases/), [Hypofractionation (fewer, larger radiotherapy doses)](https://onco.cc/terms/hypofractionation/), [Metastatic spinal cord compression (MSCC)](https://onco.cc/terms/metastatic-spinal-cord-compression/)
- ideas: [Four weeks or five treatments, not seven and a half weeks, for prostate radiotherapy](https://onco.cc/ideas/idea-pu-prostate-hypofractionation-default/), [One week of breast radiotherapy in five treatments as the default after surgery](https://onco.cc/ideas/idea-pu-five-fraction-breast-default/), [Single-fraction radiotherapy as the default for painful bone metastases](https://onco.cc/ideas/idea-acc-single-fraction-palliative-radiotherapy-default/)

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