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Hypofractionation (fewer, larger radiotherapy doses)

aka hypofractionated, hypofractionated radiotherapy, ultra-hypofractionated, ultrahypofractionation, moderate hypofractionation, fractionation, fractions, fractionated, single-fraction, five-fraction, conventional fractionation, conventionally fractionated, accelerated fractionation, dose per fraction, short-course radiotherapy, short-course, long-course

Giving radiotherapy in fewer, bigger daily doses (fractions) so a course takes one to three weeks instead of five to seven, with equal cure and side effects for many cancers. Convenience, cost and machine capacity all improve.

Normal tissue tolerates radiation better when it is split into daily fractions, historically 1.8-2 Gy over 5-7 weeks. Randomised trials showed moderate hypofractionation (2.7-3 Gy, 15-20 fractions) is equivalent in breast (START, whole-breast 40 Gy/15) and prostate (CHHiP, PROFIT), and ultra-hypofractionation (5 fractions: FAST-Forward for breast 26 Gy/5, PACE-B for prostate) also holds up. Single 8 Gy fractions suffice for bone pain. SBRT takes the principle to its extreme. Short-course (5 × 5 Gy) rectal radiotherapy is part of total neoadjuvant therapy. Adoption lags in some health systems that are paid per fraction.

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Treatment jargon

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Bone metastases and skeletal-related eventsBrachytherapy (internal radiotherapy)Gray unit (Gy)IMRT / IGRT / VMAT (modern external beam radiotherapy)Lumpectomy (breast-conserving surgery)Non-inferiority trialStereotactic body radiotherapy (SBRT / SABR)Total neoadjuvant therapy (TNT, rectal cancer)