Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, Hahn C, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8(3):145–52.

Article  PubMed  Google Scholar 

National Comprehensive Cancer Network. Invasive Breast Cancer 2023. Available from: https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 23 May 2023.

The Royal College of Radiologists. Postoperative radiotherapy for breast cancer: UK consensus statements 2016. Available from: https://www.rcr.ac.uk/publication/postoperative-radiotherapy-breast-cancer-uk-consensus-statements. Accessed 23 May 2023.

Meattini I, Becherini C, Boersma L, Kaidar-Person O, Marta GN, Montero A, et al. European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer. Lancet Oncol. 2022;23(1):e21-31.

Article  PubMed  Google Scholar 

Eraso A, Sanz J, Molla M, Reyes V, Pedro A, Arenas M, et al. Evidence-based guidelines for hypofractionated radiation in breast cancer: conclusions of the Catalan expert working group. Clin Transl Oncol. 2022;24(8):1580–7.

Article  PubMed  PubMed Central  Google Scholar 

Ontario CC. Breast irradiation in women with early stage invasive breast cancer following breast conserving surgery 2016. Available from: https://www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/841. Accessed 23 May 2023.

Wockel A, Festl J, Stuber T, Brust K, Krockenberger M, Heuschmann PU, et al. Interdisciplinary screening, diagnosis, therapy and follow-up of breast cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017): Part 2 with recommendations for the therapy of primary, recurrent and advanced breast cancer. Geburtshilfe Frauenheilkd. 2018;78(11):1056–88.

Article  PubMed  PubMed Central  Google Scholar 

Park YH, Senkus-Konefka E, Im SA, Pentheroudakis G, Saji S, Gupta S, et al. Pan-Asian adapted ESMO Clinical Practice Guidelines for the management of patients with early breast cancer: a KSMO-ESMO initiative endorsed by CSCO, ISMPO, JSMO, MOS, SSO and TOS. Ann Oncol. 2020;31(4):451–69.

Article  CAS  PubMed  Google Scholar 

Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14(11):1086–94.

Article  PubMed  Google Scholar 

Haviland JS, Mannino M, Griffin C, Porta N, Sydenham M, Bliss JM, et al. Late normal tissue effects in the arm and shoulder following lymphatic radiotherapy: Results from the UK START (Standardisation of Breast Radiotherapy) trials. Radiother Oncol. 2018;126(1):155–62.

Article  PubMed  PubMed Central  Google Scholar 

Gupta A, Khan AJ, Yegya-Raman N, Sayan M, Ahlawat S, Ohri N, et al. 5-Year results of a prospective phase 2 trial evaluating 3-week hypofractionated whole breast radiation therapy inclusive of a sequential boost. Int J Radiat Oncol Biol Phys. 2019;105(2):267–74.

Article  PubMed  PubMed Central  Google Scholar 

Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst. 2005;97(2):116–26.

Article  PubMed  Google Scholar 

Wang SL, Fang H, Song YW, Wang WH, Hu C, Liu YP, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol. 2019;20(3):352–60.

Article  PubMed  Google Scholar 

Leong N, Truong PT, Tankel K, Kwan W, Weir L, Olivotto IA. Hypofractionated nodal radiation therapy for breast cancer was not associated with increased patient-reported arm or brachial plexopathy symptoms. Int J Radiat Oncol Biol Phys. 2017;99(5):1166–72.

Article  PubMed  Google Scholar 

Bekelman JE, Sylwestrzak G, Barron J, Liu J, Epstein AJ, Freedman G, et al. Uptake and costs of hypofractionated vs conventional whole breast irradiation after breast conserving surgery in the United States, 2008–2013. JAMA. 2014;312(23):2542–50.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Coles CE, Aristei C, Bliss J, Boersma L, Brunt AM, Chatterjee S, et al. International guidelines on radiation therapy for breast cancer during the COVID-19 pandemic. Clin Oncol (R Coll Radiol). 2020;32(5):279–81.

Article  CAS  PubMed  Google Scholar 

Poppe MM, Yehia ZA, Baker C, Goyal S, Toppmeyer D, Kirstein L, et al. 5-Year update of a multi-institution, prospective phase 2 hypofractionated postmastectomy radiation therapy trial. Int J Radiat Oncol Biol Phys. 2020;107(4):694–700.

Article  PubMed  PubMed Central  Google Scholar 

Shaitelman SF, Lei X, Thompson A, Schlembach P, Bloom ES, Arzu IY, et al. Three-year outcomes with hypofractionated versus conventionally fractionated whole-breast irradiation: results of a randomized, noninferiority clinical trial. J Clin Oncol. 2018;36(35):JCO1800317.

Article  PubMed  Google Scholar 

Offersen BV, Alsner J, Nielsen HM, Jakobsen EH, Nielsen MH, Krause M, et al. Hypofractionated versus standard fractionated radiotherapy in patients with early breast cancer or ductal carcinoma in situ in a randomized phase III trial: the DBCG HYPO trial. J Clin Oncol. 2020;38(31):3615–25.

Article  PubMed  Google Scholar 

Kindts I, Laenen A, Depuydt T, Weltens C. Tumour bed boost radiotherapy for women after breast-conserving surgery. Cochrane Database Syst Rev. 2017;11(11):CD011987.

PubMed  Google Scholar 

Jones HA, Antonini N, Hart AA, Peterse JL, Horiot JC, Collin F, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27(30):4939–47.

Article  PubMed  PubMed Central  Google Scholar 

Poortmans PM, Collette L, Horiot JC, Van den Bogaert WF, Fourquet A, Kuten A, et al. Impact of the boost dose of 10 Gy versus 26 Gy in patients with early stage breast cancer after a microscopically incomplete lumpectomy: 10-year results of the randomised EORTC boost trial. Radiother Oncol. 2009;90(1):80–5.

Article  PubMed  Google Scholar 

Vicini F, WInter K, Freedman G, Arthur D, Hayman J, Rosenstein B, et al. NRG RTOG 1005: A phase III trial of hypo fractionated whole breast irradiation with concurrent boost vs conventional whole breast irradiation plus sequential boost following lumpectomy for high risk early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2022;114(3):S1.

Article  Google Scholar 

Coles CE, Haviland JS, Kirby AM, Griffin CL, Sydenham MA, Titley JC, et al. Dose-escalated simultaneous integrated boost radiotherapy in early breast cancer (IMPORT HIGH): a multicentre, phase 3, non-inferiority, open-label, randomised controlled trial. Lancet. 2023. https://doi.org/10.1016/S0140-6736(23)00619-0.

Horner-Rieber J, Forster T, Hommertgen A, Haefner MF, Arians N, Konig L, et al. Intensity Modulated Radiation Therapy (IMRT) with simultaneously integrated boost shortens treatment time and is noninferior to conventional radiation therapy followed by sequential boost in adjuvant breast cancer treatment: results of a large randomized phase III trial (IMRT-MC2 Trial). Int J Radiat Oncol Biol Phys. 2021;109(5):1311–24.

Article  PubMed  Google Scholar 

Bhattacharya IS, Haviland JS, Perotti C, Eaton D, Gulliford S, Harris E, et al. Is breast seroma after tumour resection associated with patient-reported breast appearance change following radiotherapy? Results from the IMPORT HIGH (CRUK/06/003) trial. Radiother Oncol. 2019;136:190–6.

Article  PubMed  PubMed Central  Google Scholar 

Lee G, Parmar H, Li W, Shessel A. The effect of lumpectomy cavity changes on planning dose in breast radiotherapy boost. J Med Imaging Radiat Sci. 2019;50(2):317–22.

Article  PubMed  Google Scholar 

Sayan M, Yehia ZA, Jan I, Gupta A, Vergalasova I, Reviello M, et al. Adaptive lumpectomy boost planning can reduce normal tissue exposure in patients receiving hypofractionated whole breast irradiation. Anticancer Res. 2022;42(1):53–7.

Article  PubMed  Google Scholar 

FAST-Forward Trial Management Group. FAST-Forward Protocol Version 5.1 2018 [Available from: https://www.icr.ac.uk/media/docs/default-source/default-document-library/fast-forward-protocol.pdf?sfvrsn=421a2169_0. Accessed 23 May 2023.

Brunt AM, Haviland JS, Sydenham M, Agrawal RK, Algurafi H, Alhasso A, et al. Ten-Year Results of FAST: a randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer. J Clin Oncol. 2020;38(28):3261–72.

Article  PubMed  PubMed Central  Google Scholar 

Brunt AM, Haviland JS, Wheatley DA, Sydenham MA, Alhasso A, Bloomfield DJ, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020;395(10237):1613–26.

Article  Google Scholar 

The Royal College of Radiologists. Guidelines on radiation therapy for breast cancer during the COVID-19 pandemic 2020. Available from: https://www.rcr.ac.uk/sites/default/files/breast-cancer-treatment-covid19.pdf. Accessed 23 May 2023.

Dietz JR, Moran MS, Isakoff SJ, Kurtzman SH, Willey SC, Burstein HJ, et al. Recommendations for prioritization, treatment, and triage of breast cancer patients during the COVID-19 pandemic. the COVID-19 pandemic breast cancer consortium. Breast Cancer Res Treat. 2020;181(3):487–97.

Article  CAS  PubMed  PubMed Central  Google Scholar 

Gannon MR, Dodwell D, Miller K, Horgan K, Clements K, Medina J, et al. Change in the use of fractionation in radiotherapy used for early breast cancer at the start of the COVID-19 Pandemic: a population-based cohort study of older women in England and Wales. Clin Oncol (R Coll Radiol). 2022;34(9):e400–9.

Article  CAS  PubMed  Google Scholar 

Lekx-Toniolo K, Caudrelier J-M. Trends in radiation therapy breast treatments at the Ottawa hospital cancer centre. Presentation at the Canadian Winter School Virtual Meeting 2/1/2023.

Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol. 2006;7(6):467–71.

Article  PubMed  Google Scholar 

Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20.

Article  CAS  PubMed  Google Scholar 

Wang SL, Fang H, Hu C, Song YW, Wang WH, Jin J, et al. Hypofractionated versus conventional fractionated radiotherapy after breast-conserving surgery in the modern treatment era: a multicenter, randomized controlled trial from China. J Clin Oncol. 2020;38(31):3604–14.

Article  CAS  PubMed  Google Scholar