A treasure chest of hypofractionation.

Lots more breaking news came out of #ASTRO17 yesterday...thankfully we followed etiquette and snapped some slides to help us keep up with it all. Headlining was the 5-year outcomes with post-mastectomy hypofractionation. At a median follow-up of 52 months for >800 Chinese patients, there were no differences in locoregional control or survival outcomes with 2.9 Gy x 15 versus the standard 2 Gy x 25. The caveats: First, this is relatively short follow-up, especially for the majority hormone-receptor positive cancers, and the slight trend towards more local failures with the shorter course may prove with time to fall short of non-inferiority thresholds. Second, patients undergoing reconstruction were excluded, making this data not readily applicable to many of our post-mastectomy patients. Luckily, we also have solid phase 2 data for the use of 3.33 Gy x 11 with reconstructed breasts, setting the foundation for a phase 3 Alliance trial now accruing (A221505). It’s looking like losing your breast may not have to mean losing your option for shorter-course radiation.