In the NEJM this week:
10 year results of the Canadian Hypofractionation trial for breast cancer are published, showing no difference in local control, toxicity, or cosmetic appearance. Interestingly, a new subset analysis in this paper seems to suggest that high grade cancers were not the best candidate for hypofractionation due to a higher failure rate. However in a low risk patient, this has become a standard option at Duke for the treatment of node-megative disease. Of course the caveats is that this trial does not apply to patients who are node positive and in those who have a separation >25cm. Boost was not also used in the trial; though we will occasionally offer a boost of 200cGy x 5 with the 2.66Gy x 16fx regimen extrapolating from the boost trials.
Link to the NEJM:
Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer: "The optimal schedule of radiation treatment after breast-conserving surgery for invasive breast cancer is unknown. In this study, two groups of patients received either hypofractionated radiation or a standard schedule of radiation treatment. Ten years later, the two groups had similar risks of local recurrence and a similar appearance of the breast."