Hypofractionated nodal radiotherapy in breast cancer: time for an updated standard of care?
Mené en France sur 1 256 patientes atteintes d’un carcinome mammaire invasif nécessitant une irradiation ganglionnaire après résection microscopique complète de la tumeur (âge médian : 58 ans), cet essai randomisé multicentrique de phase III évalue la non-infériorité, du point de vue du taux d'incidence d'un lymphoedème du bras ipsilatéral, d’une radiothérapie locorégionale hypofractionnée sur 3 semaine (40 Gy en 15 fractions) par rapport à une radiothérapie hypofractionnée sur 5 semaines (50 Gy en 25 fractions)
Minimising the effect of arm swelling (lymphoedema) caused by breast cancer treatment is a key goal for patients and health-care providers, given the potential detrimental effect on physical, psychological, and social wellbeing. Historically, breast axillary nodal radiotherapy was associated with major harm to patients in the 1970s and 1980s, resulting in lymphoedema and nerve damage (brachial plexopathy), which caused severe pain and loss of arm function. The causes were multifactorial, including large radiation doses, overlapping radiotherapy fields, and poor-quality radiotherapy with an absence of standardised protocols and quality assurance.1 One associated factor was the use of hypofractionated radiotherapy, defined as more than 2 Gy per treatment visit (or fraction). Breast hypofractionation was introduced at this time to address a capacity issue for radiotherapy, without testing within clinical trials. As such, hypofractionated radiotherapy was viewed subsequently with apprehension and mistrust.
The Lancet , commentaire, 2026