Hypofractionated Whole Breast Radiotherapy and Boost in Early-Stage Breast Cancer

Purpose of Review To review postlumpectomy whole breast irradiation (WBI) in early-stage breast cancer with regard to the use of hypofractionation and a tumor bed boost. Recent Findings Hypofractionation is currently standard practice for most cases of postlumpectomy WBI. A boost is recommended for women at increased risk for local recurrence due to clinical or pathologic risk factors. A sequential boost is currently standard practice for WBI with either conventional or hypofractionated radiation. Phase I-II trials of hypofractionation and concurrent boost have shown comparably low risks for local recurrence and acute and late toxicity without adding additional treatment days to WBI. Postlumpectomy WBI with hypofractionation and concurrent boost is a promising method of gaining the local control benefit of a tumor bed boost but maintaining the shorter treatment length, lower cost, and convenience of hypofractionation. Phase III trials are pending that may make this approach more widely accepted practice.