Weekly radiotherapy in elderly breast cancer patients: a comparison between two hypofractionation schedules



Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations.

Materials and methods

47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups.


After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters.


Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Data availability

All data are avalaible for analysis and review in electronic records.


  1. 1.

    Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  Google Scholar 

  2. 2.

    Darby S, McGale P, Correa C, et al. Early breast cancer trialists’ collaborative group: effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707–16.

    CAS  Article  Google Scholar 

  3. 3.

    Whelan T, MacKenzie R, Julian J, Levine M, Shelley W, Grimard L, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94:1143–50.

    Article  Google Scholar 

  4. 4.

    Bentzen SM, Agrawal RK, Aird EG. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. The Lancet. 2008;371:1098–107.

    CAS  Article  Google Scholar 

  5. 5.

    Sanz J, Rodríguez N, Foro P, et al. Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis. Clin Transl Oncol. 2017;19(4):464–9.

    CAS  Article  Google Scholar 

  6. 6.

    Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin. 2001;51:15–36.

    CAS  Article  Google Scholar 

  7. 7.

    Algara M, Sanz J, Foro P, Reig A, Lozano J, Membrive I, Lacruz M, Quera J, Fernández-Velilla E, Rodríguez de Dios N. Variación en las indicaciones de irradiación externa en el cáncer de mama. Análisis de 4.545 casos (1990-2005). Rev Senología y Patol Mam. 2007;20(3):120–4.

    Google Scholar 

  8. 8.

    Punglia RS, Weeks JC, Neville BA, Earle CC. Effect of distance to radiation treatment facility on use of radiation therapy after mastectomy in elderly women. Int J Radiat Oncol Biol Phys. 2006 Sep 1;66(1):56–63.

    Article  Google Scholar 

  9. 9.

    Morrow M. Breast disease in elderly women. Surg Clin North Am. 1994;74:145–61.

    CAS  Article  Google Scholar 

  10. 10.

    Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 2001;285:885–92.

    CAS  Article  Google Scholar 

  11. 11.

    Donato V, Valeriani M, Zurlo A. Short course radiation therapy for elderly cancer patients. Evidences from the literature review. Crit Rev Oncol/Hematol. 2003;45(3):305–11.

    Article  Google Scholar 

  12. 12.

    Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000;92:550–6.

    CAS  Article  Google Scholar 

  13. 13.

    Rovea P, Fozza A, Franco P, De Colle C. Once-weekly hypofractionated whole-breast radiotherapy after breast-conserving surgery in older patients: a potential alternative treatment schedule to daily 3-week hypofractionation. Clin Breast Cancer. 2015;15(4):270–6.

    Article  Google Scholar 

  14. 14.

    Kirova YM, Campana F, Savignoni A, et al. Breast-conserving treatment in the elderly: long-term results of adjuvant hypofractionated and normofractionated radiotherapy. Int J Radiat Oncol Biol Phys. 2009;75:76–81.

    Article  Google Scholar 

  15. 15.

    Sanz J, Zhao M, Rodríguez N, Granado R, Foro P, et al. Once-weekly hypofractionated radiotherapy for breast cancer in elderly patients: efficacy and tolerance in 486 patients. Biomed Res Int. 2018;2018:8321871.

    Article  Google Scholar 

  16. 16.

    Holloway CL, Panet-Raymond V, Olivotto I. Hypofractionation should be the new ‘standard’ for radiation therapy after breast conserving surgery. Breast. 2010;19:163–7.

    Article  Google Scholar 

  17. 17.

    Fiorentino A, Gregucci F, Mazzola R, et al. Intensity-modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elferly patients with breast cancer: comparison of acute and late toxicities. Radiol Med. 2019;124(4):309–14.

    Article  Google Scholar 

  18. 18.

    Rodríguez N, Sanz X, Dengra J, et al. Five-year outcomes, cosmesis, and toxicity with 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2013;87(5):1051–7.

    Article  Google Scholar 

  19. 19.

    Martin S, Mannino M, Rostom A, et al. Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer. Clin Oncol (R Coll Radiol). 2008;20:502–5.

    CAS  Article  Google Scholar 

  20. 20.

    Ortholan C, Hannoun-Levi JM, Ferrero JM, et al. Long-term results of adjuvant hypofractionated radiotherapy for breast cancer in elderly patients. Int J Radiat Oncol Biol Phys. 2005;61:154–62.

    Article  Google Scholar 

  21. 21.

    Algara M, Foro P, Reig A, Lacruz M, Auñón C, Valls A. Edad avanzada y neoplasia de mama. Utilidad del hipofraccionamiento. Resultados preliminares. Oncología. 1999;22(4):35–40.

    Google Scholar 

  22. 22.

    Rostom AY, Pradhan DG, White WF. Once weekly irradiation in breast cancer. Int J Radiat Oncol Biol Phys. 1987;13:551–5.

    CAS  Article  Google Scholar 

  23. 23.

    Dragun AE, Quillo AR, Riley EC, et al. Clinical investigation: breast cancer a phase 2 trial of once-weekly hypofractionated breast irradiation: first report of acute toxicity, feasibility, and patient satisfaction. Int J Radiat Oncol Biol Phys. 2013;85(3):e123–8.

    Article  Google Scholar 

  24. 24.

    FAST Trialists Group, Agrawal RK, Alhasso A, Barret-Lee PJ, et al. First results of the randomised UK FAST trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015). Radiother Oncol. 2011;100:93–100.

    Article  Google Scholar 

  25. 25.

    Brunt M, Haviland J, Sydenham M, et al. FAST phase III RCT of radiotherapy hypofractionation for treatment of early breast cancer: 10-year results (CRUKE/04/015). Int J Radiat Oncol Biol Phys. 2018;102(5):1603–4.

    Article  Google Scholar 

  26. 26.

    Sanz X, Algara M, Foro P, Reig A, Lozano J, Membrive I, Rodríguez N. Radioterapia hipofraccionada semanal en pacientes de edad avanzada con cancer de mama. Rev Senol Patol Mam. 2008;21(4):145–50.

    Google Scholar 

Download references


This study has no received any funding

Author information



Corresponding author

Correspondence to A. Manuel.

Ethics declarations

Conflict of interest

All authors declare they have no conflict of interest excepte Dr Algara that has received consulting honoraria from Sysmex and Aristo and speaking honoraria from Siemens and Roche.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

All patients signed an informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhao, M., Sanz, J., Rodríguez, N. et al. Weekly radiotherapy in elderly breast cancer patients: a comparison between two hypofractionation schedules. Clin Transl Oncol 23, 372–377 (2021). https://doi.org/10.1007/s12094-020-02430-7

Download citation


  • Breast cancer
  • Elderly patients
  • Radiotherapy
  • Weekly hypofractionation