Hypofractionated radiotherapy after mastectomy: a new frontier
Mené en Chine sur 810 patientes atteintes d'un cancer du sein à risque élevé de récidive et traitées par mastectomie (âge : 18 à 75 ans ; durée médiane de suivi : 58,5 mois), cet essai randomisé de phase III évalue, du point de vue de la récidive locorégionale à 5 ans et de la sécurité, la non infériorité d'une radiothérapie hypofractionnée (43,5 Gy administrés en 15 fractions réparties sur 3 semaines) par rapport à une radiothérapie fractionnée standard (50 Gy administrés en 25 fractions réparties sur 5 semaines)
Hypofractionation is an elegant approach that promises to help to contain the costs of cancer care and mitigate financial toxicity. For selected patients with breast cancer, considerable evidence from large randomised trials with long follow-up, primarily in the setting of breast conservation, supports the equivalent efficacy and toxicity of shorter courses of hypofractionated whole-breast radiotherapy (such as 42·5 Gy in 16 fractions 1
or 40 Gy in 15 fractions 2
) than conventional courses, which required 5 or more weeks of daily treatments. The transformative impact of hypofractionation in the setting of breast conservation 3
has also motivated investigation of hypofractionation after mastectomy. 4
In The Lancet Oncology, Shu-Lian Wang and colleagues 5
report the 5-year outcomes of a randomised, non-inferiority, open-label, phase 3 trial in China that compared postmastectomy hypofractionated radiotherapy (43·5 Gy in 15 fractions over 3 weeks) with conventional treatment (50 Gy in 25 fractions over 5 weeks).
The Lancet Oncology , commentaire, 2018