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Krug, D.* ; Baumann, R.* ; Combs, S.E. ; Duma, M.N.* ; Dunst, J.* ; Feyer, P.* ; Fietkau, R.* ; Haase, W.* ; Harms, W.* ; Hehr, T.* ; Piroth, M.D.* ; Sedlmayer, F.* ; Souchon, R.* ; Strnad, V.* ; Budach, W.*

Moderate hypofractionation remains the standard of care for whole-breast radiotherapy in breast cancer: Considerations regarding FAST and FAST-Forward.

Strahlenther. Onkol. 197, 269-280 (2021)
Publ. Version/Full Text DOI PMC
Open Access Gold (Paid Option)
Creative Commons Lizenzvertrag
Moderate hypofractionation is the standard of care for adjuvant whole-breast radiotherapy after breast-conserving surgery for breast cancer. Recently, 10-year results from the FAST and 5‑year results from the FAST-Forward trial evaluating adjuvant whole-breast radiotherapy in 5 fractions over 5 weeks or 1 week have been published. This article summarizes recent data for moderate hypofractionation and results from the FAST and FAST-Forward trial on ultra-hypofractionation. While the FAST trial was not powered for comparison of local recurrence rates, FAST-Forward demonstrated non-inferiority for two ultra-hypofractionated regimens in terms of local control. In both trials, the higher-dose experimental arms resulted in elevated rates of late toxicity. For the lower dose experimental arms of 28.5 Gy over 5 weeks and 26 Gy over 1 week, moderate or marked late effects were similar in the majority of documented items compared to the respective standard arms, but significantly worse in some subdomains. The difference between the standard arm and the 26 Gy of the FAST-Forward trial concerning moderate or marked late effects increased with longer follow-up in disadvantage of the experimental arm for most items. For now, moderate hypofractionation with 40–42.5 Gy over 15–16 fractions remains the standard of care for the majority of patients with breast cancer who undergo whole-breast radiotherapy without regional nodal irradiation after breast-conserving surgery.
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Publication type Article: Journal article
Document type Review
Corresponding Author
Keywords Breast Cancer ; Hypofractionation ; Late Toxicity ; Local Recurrence ; Radiotherapy
ISSN (print) / ISBN 0179-7158
e-ISSN 1439-099X
Journal Strahlentherapie und Onkologie : Journal of Radiation Oncology, Biology, Physics
Quellenangaben Volume: 197, Issue: 4, Pages: 269-280 Article Number: , Supplement: ,
Publisher Urban & Vogel
Publishing Place Tiergartenstrasse 17, D-69121 Heidelberg, Germany
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute of Radiation Medicine (IRM)
Grants Projekt DEAL