Open Access

Breast cancer radiobiology: The renaissance of whole breast radiation fractionation (Review)

  • Authors:
    • Abdulla Alzibdeh
    • Ramiz Abuhijlih
    • Fawzi Abuhijla
  • View Affiliations

  • Published online on: October 22, 2024     https://doi.org/10.3892/mco.2024.2795
  • Article Number: 97
  • Copyright: © Alzibdeh et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Breast cancer radiotherapy has evolved significantly, driven by decades of research into fractionation schedules aimed at optimizing treatment efficacy and minimizing toxicity. Initial trials such as NSABP B‑06 and EBCTCG meta‑analyses established the benefits of adjuvant whole‑breast irradiation in reducing local recurrence and improving survival rates. The linear‑quadratic (LQ) model provided a framework to understand tissue response to radiation, highlighting the importance of the α/β ratio in determining fractionation sensitivity. The present scoping review aimed to identify and describe hypofractionation regimens for whole breast radiotherapy and evaluate dose differences using the LQ model across proposed α/β ratios. A comprehensive PubMed search for clinical trials published since 2010 on hypo‑fractionated regimens was performed. Studies discussing α/β ratios for breast cancer have been also searched. Data on dose, fractions and α/β ratios were collected, and biologically effective dose (BED) and equivalent dose in 2 Gy fractions were calculated. The coefficient of variation for BED varied with α/β ratios, showing the lowest variability for an α/β ratio of ~3 without tumor repopulation and increased with repopulation (BED‑kT; k is a constant that depends on the repopulation rate of the tumor, and T is the total treatment time in days). Significant differences in BED variances were observed across α/β ratios (F‑statistic 219.6, P<0.0001). START trials (P, A, and B) established α/β ratios of 3‑4 Gy for breast cancer and normal tissues, confirming that hypofractionation is as effective as standard fractionation with potentially fewer late toxicities. Subsequent trials, such as FAST and FAST‑Forward, demonstrated that ultra‑hypofractionation is equivalent in tumor compared with conventional regimens. Further research is needed to gain a stronger understanding of radiobiological properties of breast cancer cells. Advances in radiotherapy technologies and the integration of biomarkers, radiomics and genomics are transforming treatment, moving towards precision medicine.
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December-2024
Volume 21 Issue 6

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Copy and paste a formatted citation
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Spandidos Publications style
Alzibdeh A, Abuhijlih R and Abuhijla F: Breast cancer radiobiology: The renaissance of whole breast radiation fractionation (Review). Mol Clin Oncol 21: 97, 2024.
APA
Alzibdeh, A., Abuhijlih, R., & Abuhijla, F. (2024). Breast cancer radiobiology: The renaissance of whole breast radiation fractionation (Review). Molecular and Clinical Oncology, 21, 97. https://doi.org/10.3892/mco.2024.2795
MLA
Alzibdeh, A., Abuhijlih, R., Abuhijla, F."Breast cancer radiobiology: The renaissance of whole breast radiation fractionation (Review)". Molecular and Clinical Oncology 21.6 (2024): 97.
Chicago
Alzibdeh, A., Abuhijlih, R., Abuhijla, F."Breast cancer radiobiology: The renaissance of whole breast radiation fractionation (Review)". Molecular and Clinical Oncology 21, no. 6 (2024): 97. https://doi.org/10.3892/mco.2024.2795