Reshaping breast cancer radiotherapy after FAST-Forward
Mené sur 4 087 patientes atteintes d'un carcinome invasif du sein de stade précoce (pT1–3, pN0–1, M0) ayant réalisé une chirurgie conservatrice ou une mastectomie (durée médiane de suivi : 10,1 ans), cet essai randomisé multicentrique de phase III évalue la non-infériorité, du point de vue du taux de récidive à 5 ou 10 ans, d'une radiothérapie hypofractionnée de courte durée (5 fractions, 1 semaine) par rapport au traitement standard (15 fractions, 3 semaines) tandis qu'une sous-étude évalue l'efficacité à 5 ans de cette radiothérapie chez 466 patientes nécessitant un traitement des ganglions axillaires
Breast radiotherapy is an integral component of breast cancer care to reduce locoregional recurrence.1 Historically, radiotherapy was delivered daily in 25–30 fractions over 5–6 weeks. Radiobiological and technological advances have enabled hypofractionation: shorter courses with larger doses per fraction achieve similar tumour control while reducing late tissue effects through reduced total dose.2 This approach was established in the first generation breast hypofractionation trials,3,4 in which the 3-week regimen (40 Gy in 15 fractions or 42·5 Gy in 16 fractions) matched the tumour control of conventional fractionation with less late tissue effects.3 In The Lancet Oncology, Adrian Murray Brunt and colleagues report 10-year results from the FAST-Forward trial,5 showing that 26 Gy in five fractions over 1 week maintains tumour control without increasing late tissue effects. Although the primary endpoint was assessed at 5 years, 10-year data confirm durability with global practice implications; the group that received 27 Gy over five fractions, with worse normal tissue effects, will not be discussed further in this Comment.
The Lancet Oncology , commentaire, 2026