Title: The Evolution of Breast Cancer Radiation Therapy: Moving Towards Hypofractionation and Fewer Fractions

Introduction:

The advancement in breast cancer radiation therapy, specifically the increase in volume and fractions, as well as the use of hypofractionated irradiation, is a significant development in the standard of care. The shift towards moderate hypofractionation, which delivers 15 fractions instead of the traditional 25 or 33 fractions, has become the new standard.

Impact on adjuvant setting:

In patients with no nodular indication indications, the Fast Forward trial results have shown that hypofractionation is non-inferior to the standard 15 fractions in adjuvant setting.

Question of Moving to 5 Fractions:

The question now is whether we should move towards irradiating both the breast and nodes with 5 fractions instead of the current standard of 15 fractions. There are two ongoing trials, one in India and the other in Canada, that will provide more data on this topic.

Results of Subsidiary Study:

The Fast Forward study included 18-90% of patients with low-risk nodular indication who underwent radiation with five fractions. The three-year results showed that it was safe, but we currently lack robust data to definitively indicate the safety and effectiveness of irradiating nodes with five fractions rather than 15 fractions.

Conclusion:

Although the shift towards hypofractionation is promising, more data from ongoing trials is necessary before moving forward with irradiating both the breast and nodes with five fractions instead of 15 fractions.