Key result
Ultra-hypofractionated radiotherapy (26 Gy over 1 week) resulted in slightly lower Grade 1 acute skin toxicity (45.3% vs 47.8%) and significantly lower lung V20 (P<0.001) than a 3-week schedule.
Why the study?
While 3-week hypofractionated radiotherapy is standard for breast cancer, 1-week ultra-hypofractionated radiotherapy is increasingly adopted, warranting a comparison of dosimetric parameters, acute toxicity, and patient compliance.
Does ultra-hypofractionated radiotherapy over 1 week improve dosimetric parameters and acute toxicity compared to hypofractionated radiotherapy over 3 weeks in patients with breast carcinoma?
RCT
randomly assigned
No
Does ultra-hypofractionated radiotherapy over 1 week improve dosimetric parameters and acute toxicity compared to hypofractionated radiotherapy over 3 weeks in patients with breast carcinoma?
Ultra-hypofractionated radiotherapy over 1 week significantly reduces radiation exposure to the heart and lungs compared to a 3-week regimen in breast cancer patients, with comparable acute skin toxicity.
Ultra-hypofractionated schedule shows comparable acute toxicity and compliance; leaves open long-term efficacy versus standard regimens in diverse populations.
Background: Hypofractionated radiotherapy (40 Gy in 15 fractions over 3 weeks) is currently the standard protocol in managing breast cancer. Recently, ultra-hypofractionated radiotherapy (26 Gy in five fractions over 1 week) has been increasingly adopted. This study aimed to compare dosimetric parameters, acute toxicity, and patient compliance between hypofractionated radiotherapy schedules delivered over 3 weeks and 1 week. Materials and Methods: This was a prospective, two-arm study conducted at a single institution among patients with breast carcinoma attending the Department of Radiotherapy from November 2022 to June 2024. Patients were randomly assigned to two groups: the study group received 26 Gy in five fractions over 1 week, while the comparison group received 40 Gy in 15 fractions over 3 weeks. The study evaluated and compared acute toxicity profiles, patient compliance, and dose constraints between both groups. Results: The occurrence of both Grade 1 and Grade 2 acute skin toxicity was slightly lower in the 26 Gy schedule compared with the 40 Gy/15 fractions schedule (45.3% vs. 47.8% and 29.7% vs. 39.1%, respectively). The average lung V20 was significantly lower in the study group (9.94 ± 7.9 Gy vs. 28.41 ± 5.5 Gy, P < 0.001). For patients with right-sided breast cancer, the average heart dose was significantly lower in the study group than in the control group (4.09 ± 2.04 Gy vs. 13.94 ± 5.8 Gy, P < 0.001). Similarly, for left-sided breast cancers, the average heart dose was significantly lower in the study group (4.14 ± 1.4 Gy vs. 15.23 ± 4.1 Gy, P < 0.001). Conclusion: The 1-week ultra-hypofractionated radiotherapy schedule appears as effective as the 3-week hypofractionated regimen in achieving disease control, with a similar acute event profile.
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Basak et al. (2026) conducted an RCT in breast carcinoma. Ultra-hypofractionated radiotherapy vs. Hypofractionated radiotherapy (40 Gy in 15 fractions over 3 weeks) was evaluated on Grade 1 acute skin toxicity. Ultra-hypofractionated radiotherapy (26 Gy over 1 week) resulted in slightly lower Grade 1 acute skin toxicity (45.3% vs 47.8%) and significantly lower lung V20 (P<0.001) than a 3-week schedule.
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