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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.
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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.
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.
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Shares Radiotherapy after mastectomy, HER2-positive breast cancer, Breast cancer (all types), Triple-negative breast cancer (TNBC) and the tag radiation-wave1.
Shares SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam), Pancreatic ductal adenocarcinoma, Prostate cancer and the tag radiation-wave1.
Shares HER2-positive breast cancer, IMRT / IGRT (modern external beam), Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer and the tag radiation-wave1.
Shares Biologically effective dose (BED) and EQD2, Prostate cancer and the tag radiation-wave1.
Shares Alpha/beta ratio, IMRT / IGRT (modern external beam) and the tag radiation-wave1.
Shares Carbon-ion synchrotrons and facilities, Unresectable stage III non-small-cell lung cancer and the tag radiation-wave1.
Shares IMRT / IGRT (modern external beam), Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer and the tag radiation-wave1.
Shares Palliation in lung cancer: breathlessness, pleural effusion, blocked airway, bone and brain, Extensive-stage small-cell lung cancer, SBRT / SABR (stereotactic radiotherapy), IMRT / IGRT (modern external beam) and the tag radiation-wave1.