Risk-adapted breast radiotherapy

Breast radiotherapy following breast-conserving surgery (BCS) has been a well established component of treatment for patients with early breast cancer for several decades. Furthermore, it is the UK that has been at the forefront of the breast radiotherapy trials journey. For example, STARTB compared 40Gy in 15 fractions (F) over three weeks with 50Gy in 25F over five weeks and found equivalent local control and less toxicity in the hypofractionation group, leading to the three-week regimen becoming standard of care. Building on this, FAST FORWARD compared the three-week regimen with one week (26Gy and 27Gy each in 5F) and found with 26Gy/5F local control was equivalent with no increase in toxicity. The timely reporting of FAST FORWARD amidst the COVID-19 pandemic meant that many patients continued to have their breast cancer radiotherapy with fewer hospital visits.

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