Moderate Hypofractionation for Regional Node Irradiation Is Safe and Effective
Mené au Danemark sur 2 908 patientes atteintes d'un cancer du sein avec atteinte ganglionnaire (durée médiane de suivi : 5,25 ans ; âge médian : 57 ans), cet essai randomisé multicentrique de phase III évalue la non-infériorité, du point de vue de l'incidence d'un lymphoedème du bras, d'une radiothérapie de 40 Gy en 15 fractions par rapport au traitement standard de 50 Gy en 25 fractions
Over the past 25 years, hypofractionation has been extensively evaluated as a strategy to de-escalate radiotherapy for breast cancer. Several randomized trials have shown moderate hypofractionation (fraction sizes of 2.7-3.2 Gy), compared with conventional fractionation (fraction size 2 Gy), for whole-breast irradiation after breast-conserving surgery is safe and effective with no significant differences in toxicity or local recurrence. This has resulted in reducing treatment from 50 Gy in 25 fractions over 5 weeks to 40-42.5 Gy in 15-16 fractions over 3 weeks and is associated with a reduction in health care costs.5 In addition to shortening overall treatment time, moderate hypofractionation has been shown to reduce acute toxicity and improve short-term quality of life. With hypofractionation, the total dose is reduced to limit the effect of increased fraction size on late effects of radiotherapy for normal tissues, for example, breast induration and shrinkage. Acute responding tissues such as skin are more sensitive to total dose than to fraction size and exhibit less toxicity, for example, skin erythema and desquamation, with hypofractionation compared with conventional fractionation.
Journal of Clinical Oncology , éditorial, 2026