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Recommendations for use of

Clinical Practice Recommendations

Please see the statements of evidence on which the recommendations are based.

Recommendations to individual women should be based on their circumstances, the absolute benefits and harms of treatment, and their personal preferences. These factors should be discussed with individual women. Women treated with conventional or hypofractionated radiotherapy should be reviewed regularly and monitored for side effects and adverse events.

It is important to note that research on hypofractionated whole breast radiotherapy for early breast cancer is continuing. Clinical judgement should be applied in the context of the currently available evidence and emerging findings from the continuing body of research.

In women with early breast cancer who require post-operative whole breast radiotherapy and for whom hypofractionated radiotherapy is being considered:
Women should be informed of the potential benefits and risks, and potential side effects and adverse events of hypofractionated radiotherapy and conventionally fractionated radiotherapy. I NBCC & NCCI14
Patient and tumour characteristics

Hypofractionated radiotherapy can be offered as a suitable alternative to conventionally fractionated radiotherapy for women:

  • aged 50 years and over
  • with pathological stage T1-2, N0, M0
  • with low or intermediate histologic grade breast cancer
  • who have undergone breast conserving surgery
  • with clear surgical margins


Cancer Australia systematic review15

ASTRO guidelines16

There is insufficient evidence to make a recommendation for or against the use of hypofractionated radiotherapy for women:

  • aged less than 50 years
  • with pathologic stage T3+ and/or N1+ tumour
  • with high histologic grade breast cancer
  • who are treated with total mastectomy
  • who receive chemotherapy and/or targeted biological therapies

Refer to patient characteristics table for characteristics of trial populations to inform clinical judgement on the suitability of hypofractionated radiotherapy for women within or outside the above criteria.


Cancer Australia systematic review15

ASTRO guidelines16

Optimal schedule

Recommended hypofractionated schedules for whole breast radiotherapy, based on current evidence are:

  • 42.5 Gy in 16 fractions given at the rate of one fraction per day, 5 fractions per week over 22 days
  • 40 Gy in 15 fractions given at the rate of one fraction per day, 5 fractions per week over 21 days

Canadian6, 11

Adverse events and toxicity
When selecting an appropriate radiotherapy schedule, consideration should be given to the possibility of adverse events including early acute reactions and late toxic effects. I Cancer Australia  systematic review15

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