Dr Wong on Hypofractionation vs Conventional Fractionation in Breast Cancer Postmastectomy

Julia S. Wong, MD, institute physician, Dana-Farber Cancer Institute, associate professor, Radiation Oncology, Harvard Medical School, discusses findings from data presented on patient-reported toxicity results from the randomized trial of fractionation following breast reconstruction (FABREC) in patients with breast cancer.

At the 2023 American Society for Radiation Oncology (ASTRO) Annual Meeting, investigators presented data on patient-reported outcomes and toxicity from the multicenter, randomized FABREC trial of hypofractionated vs conventionally fractionated postmastectomy radiation therapy in the setting of immediate prosthetic breast reconstruction. Overall, the investigators reported that the primary outcome of physical well-being and the toxicity profile of hypofractionation was comparable to the well-being and toxicities experienced with conventional fractionation. Notably, the patients treated with hypofractionation had fewer treatment breaks and required fewer unpaid hours away from work compared with those treated with conventional fractionation.

Wong states that across the different fractionation schemes, patients did not have a difference in quality-of-life (QOL) outcomes. However, when examining 6-month outcomes of patients individually, specifically younger patients, the data indicated a slight improvement in some QOL measures with shorter-course radiation compared with the standard approach, she emphasizes.

Furthermore, investigators did not observe a difference in toxicity outcomes between the shorter and the longer courses of radiation. Wong says that differences in cancer outcomes between these 2 methods were importantly also not noted, which is a vital outcome to take away from this research, she emphasizes.

A shorter radiation regimen as opposed to a longer one can be beneficial for patients, Wong continues. Moreover, this benefit is emphasized in patients who would otherwise need to commit to 2 additional weeks of treatment, which can impose a substantial burden on those juggling busy lives, family responsibilities, and work commitments, Wong explains. Therefore, shortening radiation treatment for these patients represents a practical approach that could significantly enhance their QOL, Wong concludes.