Less remains more.

Top Line: Is hypofractionated whole breast radiation non-inferior to conventional fractionation in Danish women

The Study: The Danish Breast Cancer Group had a bad initial experience with hypofractionated breast radiation in the 1970’s. So, they stuck with conventional fractionation through the years and through many landmark trials. But given the results coming from across the North Sea, they decided to give hypofractionation a second chance. The DBCG HYPO trial sought to compare toxicity (specifically breast induration) and locoregional recurrence between conventional 50 Gy in 25 fractions (CF) and hypofractionated 40 Gy in 15 fractions (HF) whole breast radiation (no nodal irradiation). Over 1800 women over age 40 with early stage, invasive (87%) or in situ (13%) breast cancer were enrolled. A lumpectomy boost was allowed and received by 23% of patients. Over a third of patients also received adjuvant systemic therapy. At 3 years, there was no significant difference in the rates of breast induration for CF (11.8%) and HF (9%) treatment. There was also no difference in other measures of late toxicity, cosmesis, or patient satisfaction. At 9 years, the risk of locoregional recurrence was also similar for CF (3.3%) and HF (3%). 

TBL: Breaking news. Hypofractionated whole breast radiation does not increase the rate of late toxicity nor increase the risk of locoregional recurrence for women with early stage breast cancer. | Offersen, J Clin Oncol 2020