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. 2022 Aug;24(8):1580-1587.
doi: 10.1007/s12094-022-02798-8. Epub 2022 Feb 21.

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  8 , Maria José Cambra  9 , Virginia García  10 , Joan Lluis Prades  11 , Josep M Borras  11 , Manuel Algara  12
Affiliations

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

Arantxa Eraso et al. Clin Transl Oncol. 2022 Aug.

Abstract

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.

Keywords: Breast cancer; Hypofractionation; Radiotherapy.

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Conflict of interest statement

None of the authors declare any conflict of interests.

Figures

Fig. 1
Fig. 1
Participating centres and number of surveyed experts
Fig. 2
Fig. 2
Methodology for the consensus-building process
Fig. 3
Fig. 3
Results of the bibliographic search
See this image and copyright information in PMC

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