The use of hypofractionated whole-breast irradiation (HF-WBI) in patients with breast cancer has more than doubled in recent years, but conventional fractionated whole-breast irradiation (CF-WBI) remains the standard, according to a study published in Clinical Breast Cancer.

The study authors analyzed National Cancer Database statistics from 2004 to 2016. The team looked at treatment data from 688,079 patients with early-stage invasive breast cancer and 248,218 patients with ductal carcinoma in situ (DCIS), all of whom had previously undergone lumpectomy.

The use of HF-WBI increased significantly over time for both groups of patients.

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For patients with invasive disease, HF-WBI was used in 0.7% of patients in 2004, 15.6% of patients in 2013, and 38.1% of patients in 2016 (P <.001).

For patients with DCIS, HF-WBI was used in 0.4% of patients in 2004, 13.4% of patients in 2013, and 34.3% of patients in 2016 (P <.001).

According to a multivariable analysis, several factors were “strongly” associated with the use of HF-WBI: age at diagnosis, nodal status, receipt of chemotherapy, and facility location.

Additional factors that were “moderately” and “statistically significantly” associated with the use of HF-WBI included race, insurance, Charlson comorbidity index, T stage, laterality, histological grade, estrogen receptor status, surgical margin, facility type and volume, median income of communities, distance to facility, and urban-rural continuum.

“HF-WBI utilization in the United States has more than doubled from 2013 to 2016,” the study authors concluded. “Although its use is close to that of CF-WBI, HF-WBI is still far from the preferred standard of care in the United States.”

Disclosures: This research was partially supported by the Breast Cancer Research Foundation and the Agency for Healthcare Research and Quality. Please see the original reference for a full list of disclosures.


Kang MM, Hasan Y, Waller J, Saulsberry L, Huo D. Has hypofractionated whole breast radiation therapy become standard of care in the United States? An updated report from National Cancer Database. Clin Breast Cancer. Published online June 7, 2021. doi:10.1016/j.clbc.2021.05.016