Quality not quantity.

Top Line: The Canadian breast hypofractionation trial demonstrated hypofractionated whole breast radiation (HF-WBI, 42.56 Gy in 16 fractions without boost) achieves noninferior local control, toxicity, and cosmesis.

The Study: The trial included an acute toxicity and quality of life (QOL) substudy. This was much smaller than the overall trial with 161 participants out of the initial 1234 enrollees. HF-WBI reduced both the peak rate and duration of acute grade 2-3 skin toxicity. For HF-WBI, skin toxicity peaked at 12% in week 4 and dropped to 0% in week 8. That’s compared to 38% at week 6 dropping to 12% at week 8 with conventional fractionation (CF). The substudy also assessed overall QOL, skin quality, breast effects, and attractiveness. QOL trajectory followed a similar pattern to skin toxicity with a fall at 2-4 weeks for HF-WBI and subsequent rise at 6-8 weeks compared to CF-WBI’s fall at 4-6 weeks and rise at 8 weeks. As one would imagine, the differences in duration of toxicity and QOL changes resulted in a smaller drop and faster recovery in multiple QOL domains with HF-WBI compared to CF-WBI. 

TBL: In case you needed more evidence, HF-WBI results in less acute toxicity and improved QOL in the Canadian HF-WBI trial. | Arsenault, Int J Radiat Oncol Biol Phys 2020