Reduced Short-Term Effects With Hypofractionated Whole-Breast Irradiation After Breast-Conserving Surgery


Key Points

  • Among acute effects, hypofractionation was associated with reduced dermatitis, pruritus, breast pain, hyperpigmentation, and fatigue.
  • At 6 months, hypofractionation was associated with reduced physician-reported fatigue and patient-reported lack of energy and trouble meeting family needs.

In a randomized trial reported in JAMA Oncology, Shaitelman et al found that hypofractionated whole-breast irradiation resulted in reduced short-term effects compared with conventional fractionation in women with stage 0 to II breast cancer undergoing breast-conserving surgery.

Study Details

In this open-label trial, 287 women aged ≥ 40 years from community-based and academic cancer centers for whom whole-breast irradiation without a third field was recommended were randomly assigned between February 2011 and February 2014 to receive hypofractionation (n = 138; 42.56 Gy/16 fractions + boost of 10.00–12.50 Gy/4–5 fractions) or conventional fractionation (n = 149; 50.00 Gy/25 fractions + boost of 10.00–14.00 Gy/5–7 fractions) after breast-conserving surgery. Patients were observed for acute effects and effects occurring during 6 months of follow-up. Patient-reported quality of life was assessed by Functional Assessment of Cancer Therapy for Patients with Breast Cancer (FACT–B). Overall, 76% of patients were overweight or obese.

Acute Effects

Among acute effects, rates of maximum physician-reported acute dermatitis (36% vs 69%, P < .001), pruritus (54% vs 81%, P < .001), breast pain (55% vs 74%, P = .001), hyperpigmentation (9% vs 20%, P = .002), and fatigue (9% vs 17%, P = .02) during irradiation were lower in patients receiving hypofractionation, with a rate of overall grade ≥ 2 acute effects being 47% vs 78%, P < .001).

6-Month Follow-up

At 6 months after treatment, the rate of physician-reported fatigue was reduced in the hypofractionation group (0% vs 6%, P = .01), and fewer hypofractionation patients reported lack of energy (23% vs 39%, P < .001) and trouble meeting family needs (3% vs 9%, P = .01). The reduction in rates of patient-reported lack of energy (odds ratio [OR] = 0.39, 95% confidence interval [CI] = 0.24–0.63) and trouble meeting family needs (OR = 0.34, 95% CI = 0.16–0.75) remained significant on multivariate analysis.

The investigators concluded: “Treatment with [hypofractionated whole-breast irradiation] appears to yield lower rates of acute toxic effects than [conventional fractionation whole-breast irradiation] as well as less fatigue and less trouble meeting family needs 6 months after completing radiation therapy. These findings should be communicated to patients as part of shared decision making.”

Benjamin D. Smith, MD, of the University of Texas MD Anderson Cancer Center, is the corresponding author of the JAMA Oncology article.

The study was supported by the American Society of Clinical Oncology (Dr. Smith), the Breast Cancer, Cancer Prevention and Research Institute of Texas, Center for Radiation Oncology Research at the University of Texas MD Anderson Cancer Center, Ann and Clarence Cazalot, and National Cancer Institute. For full disclosures of the study authors, visit

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