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Fraction prescription – external beam radiotherapy treatment for early-stage breast cancer

Why Fraction prescription becoming the preferred option for patients undergoing external beam radiotherapy treatment for early stage breast cancer

 

Search Engine/ Database/ Website Search Number Key words (include Boolean operators here) (indicate if used as keyword rather than a tagged heading-TAG) Limiters Results Useable Results
1Google

 

 8 Fractionation, breast irradiation Participant population was a representation of one major age population, the rest of the population was underrepresented therefore this information cannot apply to all patient sub-groups. There were equivalent results in patients with CF-WBI OR HF-WBI Fractionation of whole breast irradiation in patients who are experiencing an early stage of breast cancer produces very efficient results
2Google 5 Breast malignancy, external beam radiation therapy, outcomes Very high dependency on the information gotten from the studies of other researchers. External beam radiation therapy should be a fundamental factor in multimodality treatment for women The integration of external beam radiation therapy with other treatment approaches effectively reduced the risks associated with radiation thereby making treatment more beneficial.
3Google 2 5-Fraction prescription AND early breast cancer, FAST The patient population was poorly described 5-Fraction prescription treatment conducted one-weekly in the treatment of breast cancer seems to be more radio-biologically beneficial for normal tissue effects 5-Fraction prescription treatment is more suitable for patients undergoing radiation therapy for early treatment of breast cancer
4Google 2 Radiation dose hypo-fraction OR radiation therapy, breast cancer, treatment Ambiguous definition of the end-points of the study Hypo-fractional radiation therapy is convenient, safe and effective for use in patients with breast cancer Moderate use of hypo fractional prescriptions in treatment of breast cancer is a very effective treatment process.
5DuckDuckGo 1 Hypofractionation AND FAST-forward, adjuvant radiotherapy, Poorly conducted statistical planning and analysis Non-inferiority was obtained for26 Gy and 27Gy 5-fraction schedules in comparison with 40 Gy  in 15-fraction schedules Five-fraction prescription is more suitable for breast radiotherapy after current studies on phase III trials.
6Google 12 Accelerated atrial breast irradiation AND five-fraction prescription, whole breast irradiation Poorly described techniques in the methodology section Decrease in the rate of global cosmetic from a good score to a poor score after treatment. The five-fraction Accelerated atrial breast irradiation (APBI) is an effective and safe treatment process for breast cancer
7DuckDuckGo 8 Non-invasive breast branchy-therapy AND five fraction APBI Limited discussion scope Daily administration of five fraction prescriptions of APBI using non-invasive image guided breast brachytherapy (NIBB) proves to be very efficient Five fraction prescription of APBI administered using NIBB should be considered for treatment of breast cancer as it is more effective, well-tolerable and feasible.
8Google 6 Breast Cancer AND Fractionated Radiation Insufficient description of the research hypothesis and objectives Women in the control group demonstrated better cosmetic outcomes than those in the hypo fractionated radiation group Hypo fractionated WBI is non-inferior to standard radiation treatment.
9Google 3 3-D CRT, PBI, Breast cancer Population of participants in the study was too shallow no color changes more than Grade 1 erythema were detected on the skin’ The use of 3D-CRT in the administration of PBI is very feasible as it maintained minimal levels of toxicity.

 
10Google 9 Five-fraction prescription, breast cancer, conservative surgery, radiotherapy Indefinite conclusion administering five-fraction regime in radiotherapy leads to a reduction in the risk of relapse for breast cancer patients who have undergone conservative surgery.

 

 The five-fraction regie results in reduced risk of relapse and  increase in local cancer control.

 

 

 

Annotated Bibliography

Smith D.,  Bentzen M.,  Correa R.,  Hahn A., Hardenbergh H.,  Ibbott S., et al. Fractionation for whole breast irradiation. 2011. An American Society for Radiation Oncology (ASTRO) evidence-based guideline Int J Radiat Oncol Biol Phys, 81 

  • Supporting evidence
  • Meta-analysis
  • Peer-reviewed
  • Aim: make a comparison between conventional fractionation and hypo fractional fractionation whole breast irradiation in patient with breast cancer.
  • Randomized trials were used
  • Participants of the study who were mainly 50 year old women and a very small population of women of other ages.
  • Equivalent results were obtained in participants who underwent conventional fractionation and those who underwent hypo fractional fractionation.
  • Limitation: the results are not reliable since the study population used was too narrow.

 

Brown, L.C., Mutter, R.W. and Halyard, M.Y., 2015. Benefits, risks, and safety of external beam radiation therapy for breast cancer. International Journal of Women’s Health, 7, p.449.

  • Supporting evidence
  • Systematic Review
  • Peer-reviewed
  • Aim: conduct an extensive analysis on the evolution of radiation therapy in treatment of breast cancer; including its benefits and risks
  • Limitations: the review was highly dependent on the study findings of other researcher which outshined its original purpose.
  • Results: allows women to remain with their breast without having to go through mastectomy.

: Highly toxic

  • A combination of external beam radiation therapy with other treatment strategies such as five fraction prescription has the ability to produce the most efficient results for patients with breast cancer.

Brunt, A.M., Haviland, J.S., Sydenham, M., Agrawal, R.K., Algurafi, H., Alhasso, A., Barrett-Lee, P., Bliss, P., Bloomfield, D., Bowen, J. and Donovan, E., 2020. Ten-year results of FAST: a randomized controlled trial of 5-fraction whole-breast radiotherapy for early breast cancer. Journal of Clinical Oncology, 38(28), p.3261.

  • Key source
  • Meta-analysis
  • Peer-Reviewed
  • Aim: present the outcomes and normal tissue effects associated with 5-fractional prescriptions on patients with breast cancer over a period of 10 years.
  • Participants included 915 women of less than 50 years from 18 UK centers.
  • Participants had invasive breast carcinoma that was low-risk
  • Strength: primary and secondary end points of the study were clearly defined
  • Results: After 10 years, no significant difference was witnessed in the rates of normal tissue effects for 28.5 Gy/5 but the rates were higher in30 Gy/5
  • 5-Fraction prescription treatment is more suitable for patients undergoing radiation therapy for early treatment of breast cancer

Marta N., Coles C., Kaidar-Person O., Meattini I., Hijal T., Zissiadis Y., et al. 2020. The use of moderately hypofractionated post-operative radiation therapy for breast cancer in clinical practice: a critical review Crit Rev Oncol Hematol, 156 

  • Key source
  • Systematic analysis
  • Peer – reviewed
  • Aim: offer an overview of the applicability of hypo-fractional radiation therapy for patients with breast cancer.
  • Strength: the patient population was broad enough thereby making the findings of the study more representative of the general population.
  • A total of 6 randomized phase III trials were used
  • Limitation: End points of the study were simply stated and not clearly defined
  • Results: when hypo-fractional radiation is conducted moderately, it is of immense benefit to the treatment of breast cancer.

Goodman, A., 2020. Hypo-fractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial.

  • Key Source
  • Meta-analysis
  • Peer- reviewed
  • Aim: identification of a five-fraction schedule of radiation therapy which is non-inferior on the basis of local cancer control and has the same level of safety as the internationally recognized 15-fraction regimen after primary breast cancer surgery.
  • A non-inferiority, randomized and Phase III trial was conducted at 50 referral hospitals and 47 radiotherapy centers in the UK.
  • Limitation: Statistical analyses was poorly conducted.
  • Non-inferiority was obtained for26 Gy and 27Gy 5-fraction schedules in comparison with 40 Gy in 15-fraction schedules
  • Five-fraction prescription is more suitable for breast radiotherapy after current studies on phase III trials.

Grendarova, P., Quirk, S., Roumeliotis, M., Lesiuk, M., Austin, T., Bignell, K., Liu, H., Craighead, P., Wilson, J., Phan, T. and Olivotto, I.A., 2018. A phase II trial to determine the cosmetic outcomes and toxicity of 27 Gy in five-fraction accelerated partial breast irradiation: the ACCEL trial. Journal of Radiation Oncology, 7(3), pp.285-291.

  • Key Source
  • Meta-Analysis
  • Peer Reviewed
  • Aim: investigation of five-fraction APBI prescription that is done once-weekly.
  • Limitation: the methodology section seemed insufficient
  • Strengths: the primary and secondary end points were clearly defined
  • 274 females in the early stages of in situ ductal or invasive carcinoma who were undergoing breast conserving surgery were used as participants in this study.
  • 27 Gy in five fractions were delivered once-weekly
  • Results : Decrease in the rate of global cosmetic from a good sore to a poor score after treatment.
  • The five-fraction Accelerated atrial breast irradiation is an effective and safe treatment process for breast cancer

Hepel, J.T., Leonard, K.L., Sha, S., DiPetrillo, T., Wiggins, D., Graves, T.A., Edmonson, D. and Wazer, D.E., 2016. Initial Experience of Five Fraction Accelerated Partial Breast Irradiation (APBI) Using Non-Invasive Image-Guided Breast Brachytherapy (NIBB). Brachytherapy, 15, pp.S45-S46.

  • Key source
  • Meta- analysis
  • Peer Reviewed
  • Aim: to evaluate the efficiency of APBI delivered through NIBB through daily five-fraction prescriptions
  • Limitation: Limited scope of discussion
  • Result: Daily administration of five fraction prescriptions of APBI using non-invasive image guided breast branchy therapy (NIBB) proves to be very efficient
  • Five fraction prescription of APBI administered using NIBB should be considered for treatment of breast cancer as it is more effective, well-tolerable and feasible.

Whelan J., Pignol P, Levine N., Julian A., MacKenzie R., Parpia S., et al. 2010. Long-term results of hypofractionated radiation therapy for breast cancer N Engl J. Med al

  • Key Source
  • Meta Analysis
  • Peer Reviewed
  • Aim: determine optical fractionation schedules for WBI for patients who have undergone breast-conserving surgery
  • Limitation: the study’s research objectives and hypothesis were not clearly defined.
  • Result: Women in the control group demonstrated better cosmetic outcomes than those in the hypo fractionated radiation group
  • Hypo fractionated WBI is non-inferior to standard radiation treatment

 

Vicini, F.A., Remouchamps, V., Wallace, M., Sharpe, M., Fayad, J., Tyburski, L., Letts, N., Kestin, L., Edmundson, G., Pettinga, J. And Goldstein, N.S., 2003. Ongoing clinical experience utilizing 3D conformal external beam radiotherapy to deliver partial-breast irradiation in patients with early-stage breast cancer treated with breast-conserving therapy. International Journal of Radiation Oncology* Biology* Physics, 57(5), pp.1247-1253.

  • Key source
  • Meta- analysis
  • Peer reviewed
  • Aim: to investigate a clinical experience that uses 3D conformal radiation therapy to administer partial breast irradiation for patients diagnosed with early stages of breast cancer.
  • Participants; The study used 31 patients who were scheduled for post-operative radiation therapy
  • Limitations: the population of participants was too narrow.
  • Result: no color changes more than Grade 1 erythema were detected on the skin.
  • The use of 3D-CRT in the administration of PBI is very feasible as it maintained minimal levels of toxicity.

Yarnold, J. (2018). Changes in radiotherapy fractionation—breast cancer. The British journal of radiology, 92(1093), 20170849.

  • Key source
  • Systematic Review
  • Peer Reviewed
  • Aim: to determine the effectiveness of 5-fraction regime of radiotherapy delivered in a period of 1 week
  • Limitation: indefinite conclusion
  • Result: A positive result was gotten in relation to the study’s hypothesis; indicating that the administering five-fraction regime in radiotherapy leads to a reduction in the risk of relapse for breast cancer patients who have undergone conservative surgery.
  • The five-fraction regie results in reduced risk of relapse and increase in local cancer control.

 

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