Hypofractionated radiotherapy
Fewer, larger daily doses instead of the classic five to seven weeks of small ones. Large trials in breast and prostate cancer showed the same control with the same or fewer late effects and far less time in hospital.
Overview
For decades radiotherapy was given in 1.8 to 2 Gy fractions over many weeks on the assumption that small fractions spared normal tissue. The UK START trials showed that 40 Gy in 15 fractions over three weeks matched 50 Gy in 25 for breast cancer; FAST-Forward cut this to 26 Gy in five fractions over one week; CHHiP showed 60 Gy in 20 fractions was as good as 74 Gy in 37 for prostate cancer, and PACE-B and HYPO-RT-PC took prostate treatment down to five to seven sessions. Hypofractionation is now standard for most breast and prostate cases and is spreading to other sites, with obvious benefits for patients and for overstretched departments.
How it works
Tumours with a low alpha/beta ratio (breast, prostate) are as sensitive to fraction size as late-responding normal tissue, so larger fractions lose nothing in control while shortening treatment.
- One to three weeks instead of five to seven
- Same cancer control in randomised trials
- Frees machine capacity
- Long-term follow-up still accruing for the shortest schedules
- Not suitable where large volumes of normal tissue are treated
- Requires precise setup
Latest papers
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