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Hypofractionated breast irradiation in the United States: changing the paradigm through ‘socialised’ data

Hypofractionated breast irradiation in the United States: changing the paradigm through... Radiation Oncology training in the United States in the management of breast cancer has, for decades, revolved around what we considered ‘traditional’ fractionation consisting of fraction sizes of 180–200 cGy and achieving ‘traditional’ total breast/chest wall doses of 5,000–5,040 cGy in 25–28 fractions. Most of us had been trained that using moderately large doses per fraction would result in cosmetic results ranging from suboptimal to disfiguring. The literature even had examples demonstrating the superiority of cosmesis from dose reduction to 180 cGy per fraction from 200 cGy per fraction.1 Despite the fact that multiple highly respected clinical trial groups such as the National Cancer Institute of Canada (NCIC) and the National Surgical Adjuvant Breast and Bowel Project have either used primarily or allowed hypofraction for a number of decades, ‘tradition’ prevailed in the United States. With the advent of intensity-modulated radiotherapy (IMRT), it was inevitable that this technology would be used to facilitate improved dosimetry and hopefully this would translate into improved outcomes in breast cancer treatment. In the United States, the cost of therapy had been relegated to the back bench, mainly owing to the idea that the best technology should be utilised to achieve the best effect, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Radiotherapy in Practice Cambridge University Press

Hypofractionated breast irradiation in the United States: changing the paradigm through ‘socialised’ data

Journal of Radiotherapy in Practice , Volume 14 (3): 2 – May 4, 2015

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References (12)

Publisher
Cambridge University Press
Copyright
© Cambridge University Press 2015 
ISSN
1467-1131
eISSN
1460-3969
DOI
10.1017/S1460396915000175
Publisher site
See Article on Publisher Site

Abstract

Radiation Oncology training in the United States in the management of breast cancer has, for decades, revolved around what we considered ‘traditional’ fractionation consisting of fraction sizes of 180–200 cGy and achieving ‘traditional’ total breast/chest wall doses of 5,000–5,040 cGy in 25–28 fractions. Most of us had been trained that using moderately large doses per fraction would result in cosmetic results ranging from suboptimal to disfiguring. The literature even had examples demonstrating the superiority of cosmesis from dose reduction to 180 cGy per fraction from 200 cGy per fraction.1 Despite the fact that multiple highly respected clinical trial groups such as the National Cancer Institute of Canada (NCIC) and the National Surgical Adjuvant Breast and Bowel Project have either used primarily or allowed hypofraction for a number of decades, ‘tradition’ prevailed in the United States. With the advent of intensity-modulated radiotherapy (IMRT), it was inevitable that this technology would be used to facilitate improved dosimetry and hopefully this would translate into improved outcomes in breast cancer treatment. In the United States, the cost of therapy had been relegated to the back bench, mainly owing to the idea that the best technology should be utilised to achieve the best effect,

Journal

Journal of Radiotherapy in PracticeCambridge University Press

Published: May 4, 2015

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