The American Society for Radiation Oncology (ASTRO) has released evidence-based guidelines to define appropriate fractionation of whole breast irradiation (WBI).
The guidelines, published in the International Journal of Radiation Oncology Biology Physics, were created by a task force put together by the ASTRO Health Services Research Committee to answer the following questions:
- Which patients obtain equivalent results from hypofractionated WBI and conventionally fractionated WBI?
- What is the role of a tumor-bed radiation boost in patients treated with hypofractionated WBI?
- What are appropriate regiments for hypofractionated WBI and tumor-bed boost?
- What are the characteristics of an acceptable radiotherapy plan for patients treated with hypofractionated WBI?
- What insights relevant to the radiobiology of breast cancer can be gained from recently published clinical trials comparing conventionally fractionated and hypofractionated WBI?
The task force concluded that hypofractionated whole breast irradiation is just as effective as conventionally fractionated whole breast radiation for early-stage breast cancer patients who meet specific criteria. These criteria include age 50 years and older, Stage T1-2 N0, not receiving chemotherapy, relatively uniform delivery of the radiation dose, and the ability to exclude the heart from the path of the radiation beam.
For patients who do not meet these criteria, there was not enough evidence to reach a consensus for or against the use of hypofractionated WBI.
In addition, the European Society for Medical Oncology (ESMO) released an enhanced and revised set of clinical recommendations to help oncologists deliver the best quality cancer care to their patients.
The ESMO Clinical Practice Guidelines, formerly known as the ESMO Clinical Recommendations, offer evidence-based information on the incidence, diagnostic criteria, disease staging and risk assessment, treatment plans, and follow-up of different cancers, and is intended to provide users with a set of requirements for the highest standard of care for cancer patients.
Included are guidelines for breast cancer, colorectal cancer, and non-small-cell lung cancer that have been expanded to include more treatment details and further discussion of the importance of multidisciplinary plans for particular patient settings. Lung cancer is now addressed in two distinct guidelines, one covering early and locally advanced cancer, while the other focuses on metastatic disease.
Four additional guidelines have also been rewritten. These include guidelines on soft tissue sarcoma and bone sarcoma, and a guideline on the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting. One new guideline is also focused specifically on cardiotoxicity.