{"entity":{"id":"hypofractionated-radiotherapy","kind":"technology","name":"Hypofractionated radiotherapy","aka":[],"tldr":"Fewer, larger daily doses instead of the classic five to seven weeks of small ones. Large trials in breast and prostate cancer showed the same control with the same or fewer late effects and far less time in hospital.","summary":"For decades radiotherapy was given in 1.8 to 2 Gy fractions over many weeks on the assumption that small fractions spared normal tissue. The UK START trials showed that 40 Gy in 15 fractions over three weeks matched 50 Gy in 25 for breast cancer; FAST-Forward cut this to 26 Gy in five fractions over one week; CHHiP showed 60 Gy in 20 fractions was as good as 74 Gy in 37 for prostate cancer, and PACE-B and HYPO-RT-PC took prostate treatment down to five to seven sessions. Hypofractionation is now standard for most breast and prostate cases and is spreading to other sites, with obvious benefits for patients and for overstretched departments.","status":"established","asOf":"2026-09-17","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Hypofractionated_radiation_therapy"},{"label":"NICE NG131: prostate cancer, diagnosis and management","url":"https://www.nice.org.uk/guidance/ng131/chapter/Recommendations"},{"label":"Donovan et al., patient-reported outcomes 12 years after localized prostate cancer treatment (NEJM Evidence 2023)","url":"https://doi.org/10.1056/EVIDoa2300018"}],"tags":["radiation-wave1"],"related":[],"cancers":["breast-hr-positive","breast-her2-positive","tnbc","prostate"],"sections":["radiation"],"technologies":["imrt-igrt","sbrt"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["hypofractionation","alpha-beta-ratio","biologically-effective-dose"],"trials":["start-b","import-low","rapido","nct05838729"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Prostate cancer: NICE NG131 (1.3.19) says to offer hypofractionated radiotherapy, 60 Gy in 20 fractions, delivered with image-guided intensity modulated radiation therapy unless contraindicated, or conventional radiotherapy, 74 Gy in 37 fractions, to people who cannot have the shorter schedule. Twenty visits over four weeks is the NHS standard, not a compromise.","What it costs in the bowel: NICE NG131 box 2 reports moderate to severe impact of bowel habits on quality of life at 6 months in 10 out of 100 men offered radiotherapy against 3 out of 100 in each of the other two groups, settling to 2 out of 100 at 6 years. The ProtecT 12-year patient-reported outcomes found faecal leakage in 12 percent of the radiotherapy group against 6 percent of the other groups by year 12, and nocturia at least twice a night in 48 percent of the radiotherapy group, 47 percent on monitoring and 34 percent after prostatectomy. NG131 (1.3.6) also asks that men are told about the small increase in the risk of colorectal cancer after radical external beam radiotherapy."],"principle":"Tumours with a low alpha/beta ratio (breast, prostate) are as sensitive to fraction size as late-responding normal tissue, so larger fractions lose nothing in control while shortening treatment.","strengths":["One to three weeks instead of five to seven","Same cancer control in randomised trials","Frees machine capacity"],"limitations":["Long-term follow-up still accruing for the shortest schedules","Not suitable where large volumes of normal tissue are treated","Requires precise setup"],"since":2008},"route":"/technologies/hypofractionated-radiotherapy/","neighbours":{"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"},{"id":"her2-positive-early-breast-cancer","kind":"cancer","name":"Early HER2-positive breast cancer","route":"/cancers/her2-positive-early-breast-cancer/"},{"id":"tnbc-early","kind":"cancer","name":"Early triple-negative breast cancer","route":"/cancers/tnbc-early/"},{"id":"extensive-stage-sclc","kind":"cancer","name":"Extensive-stage small-cell lung cancer","route":"/cancers/extensive-stage-sclc/"},{"id":"breast-her2-positive","kind":"cancer","name":"HER2-positive breast cancer","route":"/cancers/breast-her2-positive/"},{"id":"hr-positive-early-high-risk","kind":"cancer","name":"High-risk early HR-positive breast cancer","route":"/cancers/hr-positive-early-high-risk/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"laryngeal-cancer","kind":"cancer","name":"Laryngeal and hypopharyngeal cancer","route":"/cancers/laryngeal-cancer/"},{"id":"prostate-intermediate-risk","kind":"cancer","name":"Localised prostate cancer, intermediate risk","route":"/cancers/prostate-intermediate-risk/"},{"id":"prostate-low-risk","kind":"cancer","name":"Localised prostate cancer, very low and low risk","route":"/cancers/prostate-low-risk/"},{"id":"locally-advanced-pdac","kind":"cancer","name":"Locally advanced unresectable pancreatic ductal adenocarcinoma","route":"/cancers/locally-advanced-pdac/"},{"id":"marginal-zone-lymphoma","kind":"cancer","name":"Marginal zone lymphoma","route":"/cancers/marginal-zone-lymphoma/"},{"id":"paget-disease-of-the-nipple","kind":"cancer","name":"Paget disease of the nipple","route":"/cancers/paget-disease-of-the-nipple/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"rectal-cancer","kind":"cancer","name":"Rectal cancer","route":"/cancers/rectal-cancer/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"},{"id":"stage-iii-unresectable-nsclc","kind":"cancer","name":"Unresectable stage III non-small-cell lung cancer","route":"/cancers/stage-iii-unresectable-nsclc/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"technology":[{"id":"carbon-ion-synchrotrons","kind":"technology","name":"Carbon-ion synchrotrons and facilities","route":"/technologies/carbon-ion-synchrotrons/"},{"id":"imrt-igrt","kind":"technology","name":"IMRT / IGRT (modern external beam)","route":"/technologies/imrt-igrt/"},{"id":"sbrt","kind":"technology","name":"SBRT / SABR (stereotactic radiotherapy)","route":"/technologies/sbrt/"},{"id":"fractionation-repopulation-models","kind":"technology","name":"The four Rs and accelerated repopulation","route":"/technologies/fractionation-repopulation-models/"},{"id":"linear-quadratic-model","kind":"technology","name":"The linear-quadratic model and fractionation","route":"/technologies/linear-quadratic-model/"}],"term":[{"id":"alpha-beta-ratio","kind":"term","name":"Alpha/beta ratio","route":"/terms/alpha-beta-ratio/"},{"id":"biologically-effective-dose","kind":"term","name":"Biologically effective dose (BED) and EQD2","route":"/terms/biologically-effective-dose/"},{"id":"prostate-radiotherapy-fractionation","kind":"term","name":"How many radiotherapy visits: the prostate fractionation trials","route":"/terms/prostate-radiotherapy-fractionation/"},{"id":"hypofractionation","kind":"term","name":"Hypofractionation (fewer, larger radiotherapy doses)","route":"/terms/hypofractionation/"},{"id":"tnbc-symptom-control-palliation","kind":"term","name":"Palliation in advanced triple-negative breast cancer: brain, bone, pleura, skin and end of life","route":"/terms/tnbc-symptom-control-palliation/"},{"id":"lung-palliation-breathlessness-effusion-obstruction","kind":"term","name":"Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain","route":"/terms/lung-palliation-breathlessness-effusion-obstruction/"},{"id":"post-mastectomy-radiotherapy","kind":"term","name":"Radiotherapy after mastectomy","route":"/terms/post-mastectomy-radiotherapy/"}],"trial":[{"id":"alliance-a021501","kind":"trial","name":"Alliance A021501","route":"/trials/alliance-a021501/"},{"id":"chhip","kind":"trial","name":"CHHiP","route":"/trials/chhip/"},{"id":"crest-thoracic-rt","kind":"trial","name":"CREST: consolidation thoracic radiotherapy in extensive-stage small-cell lung cancer","route":"/trials/crest-thoracic-rt/"},{"id":"dutch-bone-metastasis-study","kind":"trial","name":"Dutch Bone Metastasis Study","route":"/trials/dutch-bone-metastasis-study/"},{"id":"eortc-22881-boost","kind":"trial","name":"EORTC 22881-10882 (boost against no boost)","route":"/trials/eortc-22881-boost/"},{"id":"fast-trial","kind":"trial","name":"FAST (5-fraction whole-breast radiotherapy)","route":"/trials/fast-trial/"},{"id":"fast-forward","kind":"trial","name":"FAST-Forward","route":"/trials/fast-forward/"},{"id":"fort","kind":"trial","name":"FoRT","route":"/trials/fort/"},{"id":"hypo-rt-pc","kind":"trial","name":"HYPO-RT-PC","route":"/trials/hypo-rt-pc/"},{"id":"import-low","kind":"trial","name":"IMPORT LOW","route":"/trials/import-low/"},{"id":"turrisi-intergroup-0096","kind":"trial","name":"Intergroup 0096 (Turrisi): twice-daily versus once-daily thoracic radiotherapy","route":"/trials/turrisi-intergroup-0096/"},{"id":"pace-b","kind":"trial","name":"PACE-B","route":"/trials/pace-b/"},{"id":"preopanc-2","kind":"trial","name":"PREOPANC-2","route":"/trials/preopanc-2/"},{"id":"profit-trial","kind":"trial","name":"PROFIT (Prostate Fractionated Irradiation Trial)","route":"/trials/profit-trial/"},{"id":"rapid","kind":"trial","name":"RAPID (accelerated partial-breast irradiation)","route":"/trials/rapid/"},{"id":"rapido","kind":"trial","name":"RAPIDO","route":"/trials/rapido/"},{"id":"rtog-0415","kind":"trial","name":"RTOG 0415","route":"/trials/rtog-0415/"},{"id":"start-a","kind":"trial","name":"START-A (UK Standardisation of Breast Radiotherapy, trial A)","route":"/trials/start-a/"},{"id":"start-b","kind":"trial","name":"START-B (UK Standardisation of Breast Radiotherapy)","route":"/trials/start-b/"},{"id":"nct05838729","kind":"trial","name":"Study of RiMO-301 and Radiotherapy With PD-1 Inhibitor for the Treatment of Head-Neck Cancer","route":"/trials/nct05838729/"},{"id":"supremo","kind":"trial","name":"SUPREMO (BIG 2-04)","route":"/trials/supremo/"}]}}