title: First results of the randomised UK FAST Trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015).
abstract: OBJECTIVE
  Randomised trials testing 15- or 16-fraction regimens of adjuvant radiotherapy in women with early breast cancer have reported favourable outcomes compared with standard fractionation. To evaluate hypofractionation further, two 5-fraction schedules delivering 1 fraction per week have been tested against a 25-fraction regimen.
  
  
  METHODS
  Women aged ⩾50years with node negative early breast cancer were randomly assigned after microscopic complete tumour resection to 50Gy in 25 fractions versus 28.5 or 30Gy in 5 once-weekly fractions of 5.7 or 6.0Gy, respectively, to the whole breast. The primary endpoint was 2-year change in photographic breast appearance.
  
  
  RESULTS
  Nine hundred and fifteen women were recruited from 2004 to 2007. Seven hundred and twenty-nine patients had 2-year photographic assessments. Risk ratios for mild/marked change were 1.70 (95% CI 1.26-2.29, p<0.001) for 30Gy and 1.15 (0.82-1.60, p=0.489) for 28.5Gy versus 50Gy. Three-year rates of physician-assessed moderate/marked adverse effects in the breast were 17.3% (13.3-22.3%, p<0.001) for 30Gy and 11.1% (7.9-15.6%, p=0.18) for 28.5Gy compared with 9.5% (6.5-13.7%) after 50Gy. With a median follow-up in survivors of 37.3months, 2 local tumour relapses and 23 deaths have occurred.
  
  
  CONCLUSIONS
  At 3years median follow-up, 28.5Gy in 5 fractions is comparable to 50Gy in 25 fractions, and significantly milder than 30Gy in 5 fractions, in terms of adverse effects in the breast.
authors.forename: Rajiv K
authors.initials: RK
authors.lastname: Agrawal
authors.forename: Abdulla
authors.initials: A
authors.lastname: Alhasso
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Barrett-Lee
authors.forename: Judith M
authors.initials: JM
authors.lastname: Bliss
authors.forename: Peter
authors.initials: P
authors.lastname: Bliss
authors.forename: David
authors.initials: D
authors.lastname: Bloomfield
authors.forename: Joanna
authors.initials: J
authors.lastname: Bowen
authors.forename: A Murray
authors.initials: AM
authors.lastname: Brunt
authors.forename: Ellen
authors.initials: E
authors.lastname: Donovan
authors.forename: Marie
authors.initials: M
authors.lastname: Emson
authors.forename: Andrew
authors.initials: A
authors.lastname: Goodman
authors.forename: Adrian
authors.initials: A
authors.lastname: Harnett
authors.forename: Joanne S
authors.initials: JS
authors.lastname: Haviland
authors.forename: Ronald
authors.initials: R
authors.lastname: Kaggwa
authors.forename: James P
authors.initials: JP
authors.lastname: Morden
authors.forename: Anne
authors.initials: A
authors.lastname: Robinson
authors.forename: Sandra
authors.initials: S
authors.lastname: Simmons
authors.forename: Alan
authors.initials: A
authors.lastname: Stewart
authors.forename: Mark A
authors.initials: MA
authors.lastname: Sydenham
authors.forename: Isabel
authors.initials: I
authors.lastname: Syndikus
authors.forename: Jean
authors.initials: J
authors.lastname: Tremlett
authors.forename: Yat
authors.initials: Y
authors.lastname: Tsang
authors.forename: Duncan
authors.initials: D
authors.lastname: Wheatley
authors.forename: Karen
authors.initials: K
authors.lastname: Venables
authors.forename: John R
authors.initials: JR
authors.lastname: Yarnold
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging