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

• Arantxa Eraso ^[1] ; Javier Sanz ^[2] ; Meritxell Mollà ^[3] ; Vicky Reyes ^[4] ; Agustí Pedro ^[5] ; Meritxell Arenas ^[6] ; Evelyn Martinez ^[7] ; Rosa Ballester ^[1] ; Maria José Cambra ^[9] ; Virginia García ^[8] ; Joan Lluis Prades ^[7] ; JosepM. Borras ^[7] ; Manuel Algara ^[2]
  1. [1] Institute Catalá Oncología

     Institute Catalá Oncología

     Barcelona, España

     
  2. [2] Hospital del Mar

     Hospital del Mar

     Barcelona, España

     
  3. [3] Hospital Clinic Barcelona

     Hospital Clinic Barcelona

     Barcelona, España

     
  4. [4] Hospital Vall d'Hebron

     Hospital Vall d'Hebron

     Barcelona, España

     
  5. [5] Hospital de la Santa Creu i Sant Pau

     Hospital de la Santa Creu i Sant Pau

     Barcelona, España

     
  6. [6] Hospital Universitari Sant Joan de Reus

     Hospital Universitari Sant Joan de Reus

     Reus, España

     
  7. [7] Hospital Duran i Reynals

     Hospital Duran i Reynals

     Barcelona, España

     
  8. [8] Hospital Universitario Arnau de Vilanova

     Hospital Universitario Arnau de Vilanova

     Lérida, España

     
  9. [9] Radiation Oncology Deparment, Hospital General de Catalunya, Sant Cugat del Vallés

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 24, Nº. 8, 2022, págs. 1580-1587
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Introduction Daily, 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 methods Consensus-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.

    Results Consensus 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.

    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.