Evidence-based guidelines for hypofractionated radiation in breast cancer: conclusions of the Catalan expert working group

Arantxa Eraso,Vicky Reyes,Rosa Ballester,Maria José Cambra,Evelyn Martinez,Josep M Borras,Manuel Algara,Meritxell Mollà,Agustí Pedro,Javier Sanz,Meritxell Arenas,Virginia García,Joan Lluis Prades

doi:10.1007/s12094-022-02798-8

Arantxa Eraso, Vicky Reyes + Show 11 more

Open Access

PDF Available

https://doi.org/10.1007/s12094-022-02798-8

Copy DOI

Export

Save

Cite

Abstract
Highlights/Summary
Full-Text PDF
Similar Papers

Abstract

Listen

IntroductionDaily, moderate hypofractionation has become standard treatment for breast cancer following breast-conserving surgery, although substantial variation exists in its use. This paper describes the generation of consensus-based recommendations for the utilisation of this therapy at the healthcare system level and compares these to American Society for Radiation Oncology (ASTRO) guidelines.Materials and methodsConsensus-based guidelines were developed in three steps, including a systematic literature review and involvement of radiation oncologists specialising in breast cancer in Catalonia: (a) creation of a working group and evidence review; (b) consideration of the levels of evidence and agreement on the formulation of survey questions; and (c) performance of survey and development of consensus-based recommendations. Results were compared to the ASTRO recommendations.ResultsConsensus was above 80% for 10 of the 14 survey items. Experts supported hypofractionated radiotherapy for all breast cancer patients aged 40 years or more; with invasive carcinoma and breast-conserving surgery; without radiation of lymph nodes; and regardless of the tumour size, histological grade, molecular subtype, breast size, laterality, other treatment characteristics, or need for a boost. Over half favoured its use in all situations, even where available scientific evidence is insufficient. The resulting recommendations and the quality of the evidence are comparable to those from ASTRO, despite some differences in the degree of consensus.ConclusionSpecialists agree that hypofractionation is the standard treatment for breast cancer following breast-conserving surgery, but some specific areas require a higher level of evidence before unequivocally extending indications.

Highlights

Moderate hypofractionation has become standard treatment for breast cancer following breast-conserving surgery, substantial variation exists in its use
Our group assessed its use for breast cancer in Catalonia, Spain [11], finding that it ranged from 8.9 to 74.7% of patients treated with a curative intent
This study describes the methods used to reach a consensus as well as the resulting recommendations as they compare to the American Society for Radiation Oncology (ASTRO) guidelines [12]

Summary

Introduction

Moderate hypofractionation has become standard treatment for breast cancer following breast-conserving surgery, substantial variation exists in its use. Experts supported hypofractionated radiotherapy for all breast cancer patients aged 40 years or more; with invasive carcinoma and breast-conserving surgery; without radiation of lymph nodes; and regardless of the tumour size, histological grade, molecular subtype, breast size, laterality, other treatment characteristics, or need for a boost. The resulting recommendations and the quality of the evidence are comparable to those from ASTRO, despite some differences in the degree of consensus. Conclusion Specialists agree that hypofractionation is the standard treatment for breast cancer following breast-conserving surgery, but some specific areas require a higher level of evidence before unequivocally extending indications. Following breast-conserving surgery for breast cancer, daily, moderate hypofractionation has become standard treatment [1, 2]. Specific indications for the treatment varied, both between services and among the different professionals that staff fed them

Methods

Results

Conclusion