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Giving radiotherapy in fewer, bigger daily doses (fractions) so a course takes one to three weeks instead of five to seven. Randomised trials showed equal control and side effects in breast (START, FAST-Forward) and prostate (CHHiP, PACE-B) cancer, and a single dose suffices for bone pain; adoption lags where health systems are paid per fraction.
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.
Shares PROFIT (Prostate Fractionated Irradiation Trial), RTOG 0415, How many radiotherapy visits: the prostate fractionation trials, CHHiP.
Shares RTOG 0415, How many radiotherapy visits: the prostate fractionation trials, CHHiP, Non-inferiority margin and equivalence trials.
Shares FAST (5-fraction whole-breast radiotherapy), START-A (UK Standardisation of Breast Radiotherapy, trial A), START-B (UK Standardisation of Breast Radiotherapy), The linear-quadratic model and fractionation.
Shares Tumour bed boost, RAPID (accelerated partial-breast irradiation), Partial-breast irradiation, Hypofractionated radiotherapy.
Shares Four weeks or five treatments, not seven and a half weeks, for prostate radiotherapy, One week of breast radiotherapy in five treatments as the default after surgery, Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH, Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation.
Shares RAPID (accelerated partial-breast irradiation), Partial-breast irradiation, Lumpectomy (breast-conserving surgery), Breast cancer (all types).
Shares Tumour bed boost, Lumpectomy (breast-conserving surgery), Hypofractionated radiotherapy, Breast cancer (all types).
Shares START-A (UK Standardisation of Breast Radiotherapy, trial A), START-B (UK Standardisation of Breast Radiotherapy), One week of breast radiotherapy in five treatments as the default after surgery.