Fraction size in radiation treatment for breast conservation in early breast cancer

James, Melissa L., Lehman, Margot, Hider, Phil N., Jeffery, Mark, Hickey, Brigid E. and Francis, Daniel P. (2010) Fraction size in radiation treatment for breast conservation in early breast cancer. Cochrane Database of Systematic Reviews, 11: . doi:10.1002/14651858.CD003860.pub3

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Author James, Melissa L.
Lehman, Margot
Hider, Phil N.
Jeffery, Mark
Hickey, Brigid E.
Francis, Daniel P.
Title Fraction size in radiation treatment for breast conservation in early breast cancer
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2010-01-01
Year available 2008
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD003860.pub3
Open Access Status File (Publisher version)
Issue 11
Total pages 50
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Abstract Background
Formatted abstract
Shortening the duration of radiation therapy would benefit women with early breast cancer treated with breast conserving surgery. It may also improve access to radiation therapy by improving efficiency in radiation oncology departments globally. This can only happen if the shorter treatment is as effective and safe as conventional radiation therapy. This is an updated version of the original Cochrane Review published in Issue 3, 2008.

To determine the effect of altered radiation fraction size on outcomes for women with early breast cancer who have undergone breast conserving surgery.

Search methods
We searched the Cochrane Breast Cancer Group Specialised Register, MEDLINE, EMBASE and the WHO ICTRP search portal to June 2009, reference lists of articles and relevant conference proceedings. We applied no language constraints.

Selection criteria
Randomised controlled trials of unconventional versus conventional fractionation in women with early breast cancer who had undergone breast conserving surgery.

Data collection and analysis
The authors performed data extraction independently, with disagreements resolved by discussion. We sought missing data from trial authors.

Main results
Four trials reported on 7095 women. The women were highly selected: tumours were node negative and 89.8% were smaller than 3 cm. Where the breast size was known, 87% had small or medium breasts. The studies were of low to medium quality. Unconventional fractionation (delivering radiation therapy in larger amounts each day but over fewer days than with conventional fractionation) did not affect: (1) local recurrence risk ratio (RR) 0.97 (95% CI 0.76 to 1.22, P = 0.78), (2) breast appearance RR 1.17 (95% CI 0.98 to 1.39, P = 0.09), (3) survival at five years RR 0.89 (95% CI 0.77 to 1.04, P = 0.16). Acute skin toxicity was decreased with unconventional fractionation: RR 0.21 (95% CI 0.07 to 0.64, P = 0.007).

Authors' conclusions
Two new studies have been published since the last version of the review, altering our conclusions. We have evidence from four low to medium quality randomised trials that using unconventional fractionation regimens (greater than 2 Gy per fraction) does not affect local recurrence, is associated with decreased acute toxicity and does not seem to affect breast appearance or late toxicity for selected women treated with breast conserving therapy. These are mostly women with node negative tumours smaller than 3 cm and negative pathological margins. Long-term follow up (> 5 years) is available for a small proportion of the patients randomised. Longer follow up is required for a more complete assessment of the effect of altered fractionation.
Keyword Breast cancer
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ
Additional Notes Article number CD003860.

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
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Created: Fri, 04 Apr 2014, 19:44:26 EST by Brigid Hickey on behalf of Medicine - Mater Hospital