Table 2.
Outcomes and equivalent doses of the prospective randomised studies comparing conventional with hypofractionation schedules in breast-cancer patients.
| RMH/GOC611 | START A712 | START B812 | OCOG514 | Beijing Trial17 | |
|---|---|---|---|---|---|
| Hypofractionated schedule | 42.9 Gy / 13 fractions | 39 Gy / 13 fractions | 40 Gy / 15 fractions | 42.6 Gy / 16 fractions | 43.5 / 15 fractions |
| 39 Gy / 13 fractions | 41.6 Gy/ 13 fractions | ||||
|
EQD2 α/β = 3(Dose level 100%) |
54.05 Gy (for 42.9 Gy) 46.80 Gy (for 39 Gy) |
51.58 Gy (for 41.6 Gy) 46.80 Gy (for 39 Gy) |
45.42 Gy | 48.18 Gy | 51.33 Gy |
| 10-year local recurrence (%) | |||||
| CF-WBI arm (50 Gy /25 fractions) | 12.1 | 6.7 | 5.2 | 7.5 | 8.1a |
| HF-WBI (42.9 Gy / 13 fractions) | 9.6 | – | – | – | – |
| HF-WBI (39 Gy / 13 fractions) | 14.8 | 8.1 | – | – | – |
| HF-WBI (41.6 Gy / 13 fractions) | – | 5.6 | – | – | – |
| HF-WBI (42.6 Gy / 16 fractions) | – | – | – | 7.4 | – |
| HF-WBI (40 Gy / 15 fractions) | – | – | 3.8 | – | – |
| HF-WBI (43.5 / 15 fractions) | – | – | – | – | 8.3a |
| Late toxic effects | |||||
| Skin (grade 3) - % | 2.7 (CF-WBI) versus 2.5 (HF-WBI) | 0.0 (CF-WBI) versus < 1.0 (HF-WBI) | |||
| Subcutaneous tissue (grade 3) - % | 3.6 (CF-WBI) versus 2.5 (HF-WBI) | – | |||
| Lymphoedema (grade 3) - % | 16.3 (CF-WBI) versus 22.5(HF – 41.6 Gy) versus 8.2 (HF – 39 Gy) | 13.5 (CF-WBI) versus 4.7 (HF-WBI | – | 1.0 (CF-WBI) versus 1.0 (HF-WBI) | |
| Breast shrinkage | 36.2 (CF-WBI) versus 34.2 (HF – 42.9 Gy) versus 44.4 (HF – 39 Gy) | 34.2 (CF-WBI) versus 31.4 (HF – 41.6 Gy) versus 30.0 (HF – 39 Gy) | 31.2 (CF-WBI) versus 26.2 (HF-WBI | ||
| Cosmetic outcome (EORTC Scale) | |||||
| Excellent or good - % | 71.3 (CF-WBI) versus 69.8 (HF-WBI) | ||||
| Fair /poor - % | 28.8 (CF-WBI) versus 25.6 (HF – 42.9 Gy) versus 42.0 (HF – 39 Gy) | ||||
Equivalent doses are calculated to be compared with a 2 Gy per fraction schedule (EQD2).
RMH/GOC = Royal Marsden Hospital/Gloucestershire Oncology Centre.
OCOG = Ontario Clinical Oncology Group.
START = Standardization of Breast Radiotherapy Trial.
CF-WBI = conventionally-fractionated whole breast irradiation.
HF-WBI = hypofractionated whole breast irradiation.
a
5-year local recurrence.