Postoperative radiotherapy for breast cancer: hypofractionation RCR consensus statements
Date: 2021
Date of next review: 2024
The Royal College of Radiologist’s (RCR) 2016 breast consensus statements made recommendations on hypofractionation. There was consensus, with strong support, that there was no indication to use more than 15 fractions for the breast, chest wall or nodal areas.
Following the FAST-Forward trial primary endpoint publication, the following statements were agreed in 2020 are intended to supplement the 2016 statements.
The new statements for postoperative radiotherapy for breast cancer hypofraction are:
- Consensus statement 1: Offer 26 Gray (Gy) in five fractions over one week for whole breast radiotherapy.
- Consensus statement 2: Offer 26 Gy in five fractions over one week for chest wall radiotherapy.
- Consensus statement 3: Consider 26 Gy in five fractions over one week for chest wall radiotherapy with reconstruction.
- Consensus statement 4: Offer 26 Gy in five fractions over one week for partial breast radiotherapy.
- Consensus statement 5: Consider 28.5 Gy in five fractions over five weeks instead of 26 Gy in five fractions over one week for patients with significant co-morbidities and/or frailty that make daily radiotherapy difficult.
- Consensus statement 6: Fifteen fractions over three weeks is the current standard of care for breast nodal radiotherapy. Consider 26 Gy in five fractions for nodal radiotherapy (excluding the internal mammary chain [IMC]) only for patients with significant co-morbidities while awaiting the two-year normal tissue results of the FAST-Forward nodal sub-study (due to report in 2021).
- Consensus statement 7: For patients requiring a boost, offer:
- 26 Gy in five fractions whole breast radiotherapy plus either a sequential normofractionated boost or a hypofractionated boost (delivered in no more than five fractions as per the RCR Postoperative radiotherapy for breast cancer: UK consensus statements, 2016)
or - 15 fraction simultaneous integrated boost (SIB), for example, 48 Gy to boost volume and 40 Gy to rest of breast all over three weeks.
- 26 Gy in five fractions whole breast radiotherapy plus either a sequential normofractionated boost or a hypofractionated boost (delivered in no more than five fractions as per the RCR Postoperative radiotherapy for breast cancer: UK consensus statements, 2016)
