Tumors of female reproductive systemTumors of female reproductive systemОпухоли женской репродуктивной системы1994-40981999-8627Publishing House ABV Press17610.17650/1994-4098-2011-0-3-45-53MAMMOLOGY. TREATMENTМАММОЛОГИЯ. ЛЕЧЕНИЕHypofractionated radiotherapy regimens after organ-sparing surgery for stages I–IIa breast cancerГипофракционированные режимы лучевой терапии после органосохраняющих операций по поводу рака молочной железы I–IIа стадийEfimkinaYu. V.ЕфимкинаЮ. В.
Russian Federation
yulia@yandex.ruGladilinaI. A.ГладилинаИ. А.
Russian Federation
NechushkinM. I.НечушкинМ. И.
Russian Federation
KozlovO. V.КозловО. В.
Russian Federation
Department of Radiosurgery, N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, MoscowОтделение радиохирургии РОНЦ им. Н.Н. Блохина РАМН, Москва140820113455314082014140820142011https://ojrs.abvpress.ru/ojrs/article/view/176

The results of basic clinical randomized trials of hypofractionated (HF) radiotherapy (R T) regimens used after organ-sparing su rgery for Stages I-IIa breast cancer (BC) were analyzed. The HF adjuvant RT regimens were shown to be safe and an alternative to the standard RT in patients with BC after organ-saving operations.

Проанализированы результаты основных клинических рандомизированных исследований, посвященных применению гипофракционированных (ГФ) режимов лучевой терапии (ЛТ) после органосохраняющих операций у больных раком молочной железы (РМЖ) I–IIа стадий. Показано, что ГФ-режимы адъювантной ЛТ у пациенток с РМЖ после органосохраняющих операций являются безопасными и могут служить альтернативой стандартной ЛТ.

breast cancerradiotherapyhypofractionated regimenрак молочной железылучевая терапиягипофракционированный режим1. Brunt A.M/, Sydenham M., Bliss J. et al. A 5-fraction regimen of adjuvant radiotherapy for women with early breast cancer: First analysis of the randomized UK FAST trial (ISRCTN62488883, CRUKE/04/015). Eur J Cancer 2009;7(Suppl):2.Brunt A.M/, Sydenham M., Bliss J. et al. A 5-fraction regimen of adjuvant radiotherapy for women with early breast cancer: First analysis of the randomized UK FAST trial (ISRCTN62488883, CRUKE/04/015). Eur J Cancer 2009;7(Suppl):2.2. Clarke M., Collins R. Darby S. et al.; Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomized trials. Lancet 2005;366:2087–106.Clarke M., Collins R. Darby S. et al.; Early Breast Cancer Trialists' Collaborative Group (EBCTCG), Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: An overview of the randomized trials. Lancet 2005;366:2087–106.3. EagLe S., HaviLandz J., Yarnold J. 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 2008;20:502–5.EagLe S., HaviLandz J., Yarnold J. 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 2008;20:502–5.4. Fujii O., Hiratsuka J., Nagase N. et al. Whole-breast radiotherapy with shorter fractionation schedules following breast- conserving surgery: short-term morbidity and preliminary outcomes. Breast Cancer 2008;15(1):86–92.Fujii O., Hiratsuka J., Nagase N. et al. Whole-breast radiotherapy with shorter fractionation schedules following breast- conserving surgery: short-term morbidity and preliminary outcomes. Breast Cancer 2008;15(1):86–92.5. Harnett A. Fewer fractions of adjuvant external beam radiotherapy for early breast cancer are safe and effective and can now be the standard of care. Why the UK’s NICE accepts fewer fractions as the standard of care for adjuvant radiotherapy in early breast cancer. Breast 2010;19:159–62.Harnett A. Fewer fractions of adjuvant external beam radiotherapy for early breast cancer are safe and effective and can now be the standard of care. Why the UK’s NICE accepts fewer fractions as the standard of care for adjuvant radiotherapy in early breast cancer. Breast 2010;19:159–62.6. Théberge V., Whelan T., Shaitelman S.F., Vicini F.A. Altered fractionation: rationale and justification for whole and partial breast hypofractionated radiotherapy. Semin Radiat Oncol 2011;21(1):55–65.Théberge V., Whelan T., Shaitelman S.F., Vicini F.A. Altered fractionation: rationale and justification for whole and partial breast hypofractionated radiotherapy. Semin Radiat Oncol 2011;21(1):55–65.7. Dinshaw K.A., Sarin R., Budrukkar A.N. et al. Safety and feasibility of breast conserving therapy in Indian women: Two decades of experience at Tata Memorial Hospital. J Surg Oncol 2006;94:105–13.Dinshaw K.A., Sarin R., Budrukkar A.N. et al. Safety and feasibility of breast conserving therapy in Indian women: Two decades of experience at Tata Memorial Hospital. J Surg Oncol 2006;94:105–13.8. Douglas B.G. Superfractionation: its rationale and anticipated benefits. Int J Radiat Oncol Biol Phys 1982;8:1143–53.Douglas B.G. Superfractionation: its rationale and anticipated benefits. Int J Radiat Oncol Biol Phys 1982;8:1143–53.9. Fisher B., Bauer M., Margolese R. et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312(11):665–73.Fisher B., Bauer M., Margolese R. et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312(11):665–73.10. Froud P.J., Mates D., Jackson J.S. et al. Effect of time interval between breast- conserving surgery and radiation therapy on ipsilateral breast recurrence. Int J Radiat Oncol Biol Phys 2000;46(2):363–72.Froud P.J., Mates D., Jackson J.S. et al. Effect of time interval between breast- conserving surgery and radiation therapy on ipsilateral breast recurrence. Int J Radiat Oncol Biol Phys 2000;46(2):363–72.11. Galecki F., Hicer-Grzenkowicz J., Grudzien-Kowalska M. et al. Radiation- induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer — a review. Acta Oncol 2006;45:280–4.Galecki F., Hicer-Grzenkowicz J., Grudzien-Kowalska M. et al. Radiation- induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer — a review. Acta Oncol 2006;45:280–4.12. Owen J.R., Ashton A., Bliss J.M. et al. Effect of radiotherapy fraction size on tumor control in patients with early-stage breast cancer after local tumor excision: long-term results of a randomized trial. Lancet Oncol 2006;7(6):467–71.Owen J.R., Ashton A., Bliss J.M. et al. Effect of radiotherapy fraction size on tumor control in patients with early-stage breast cancer after local tumor excision: long-term results of a randomized trial. Lancet Oncol 2006;7(6):467–71.13. Shelley W., Brundage M., Hayter C. et al. A shorter fractionation schedule for postlumpectomy breast cancer patients. Int J Radiat Oncol Biol Phys 2000;47(5):1219–28.Shelley W., Brundage M., Hayter C. et al. A shorter fractionation schedule for postlumpectomy breast cancer patients. Int J Radiat Oncol Biol Phys 2000;47(5):1219–28.14. Martin S., Mannino M., Rostom A. et al. Clinical Trials and Statistics Unit (ICR- CTSU), Institute of Cancer Research, Sutton, Surrey, UK.Martin S., Mannino M., Rostom A. et al. Clinical Trials and Statistics Unit (ICR- CTSU), Institute of Cancer Research, Sutton, Surrey, UK.15. Whelan T., MacKenzie R., Julian J. et al.; START Trialists' Group Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node- negative breast cancer. J Natl Cancer Inst 2002;94(15):1143–50.Whelan T., MacKenzie R., Julian J. et al.; START Trialists' Group Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node- negative breast cancer. J Natl Cancer Inst 2002;94(15):1143–50.16. Johansson S., Svensson H., Denekamp J. Timescale of evolution of late radiation injury after postoperative radiotherapy of breast cancer patients. Int J Radiat Oncol Biol Phys 2000;48:745–50.Johansson S., Svensson H., Denekamp J. Timescale of evolution of late radiation injury after postoperative radiotherapy of breast cancer patients. Int J Radiat Oncol Biol Phys 2000;48:745–50.17. Ma A.M., Barone J., Wallis A.E. et al. Noncompliance with adjuvant radiation, chemotherapy, or hormonal therapy in breast cancer patients. Am J Surg 2008;196:500–4.Ma A.M., Barone J., Wallis A.E. et al. Noncompliance with adjuvant radiation, chemotherapy, or hormonal therapy in breast cancer patients. Am J Surg 2008;196:500–4.18. McCarthy E.P., Ngo L.H., Roetzheim R.G. et al. Disparities in breast cancer treatment and survival for women with disabilities. Ann Intern Med 2006;145:637–45.McCarthy E.P., Ngo L.H., Roetzheim R.G. et al. Disparities in breast cancer treatment and survival for women with disabilities. Ann Intern Med 2006;145:637–45.19. Pignol J.P., Olivotto I., Rakovitch E. et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008;26(13):2085–92.Pignol J.P., Olivotto I., Rakovitch E. et al. A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis. J Clin Oncol 2008;26(13):2085–92.20. Dewar J.A., Benhamou S., Benhamou E. et al. Cosmetic results following lumpectomy, axillaries dissection and radiotherapy for small breast cancers. Radiother Oncol 1988;12(4):273–80.Dewar J.A., Benhamou S., Benhamou E. et al. Cosmetic results following lumpectomy, axillaries dissection and radiotherapy for small breast cancers. Radiother Oncol 1988;12(4):273–80.21. Olsen N.K., Pfeiffer P., Johannsen L. et al. Radiation-induced brachial plexopathy: neurological follow-up in 161 recurrence- free breast cancer patients. Int J Radiat Oncol Biol Phys 1993;26:43–9.Olsen N.K., Pfeiffer P., Johannsen L. et al. Radiation-induced brachial plexopathy: neurological follow-up in 161 recurrence- free breast cancer patients. Int J Radiat Oncol Biol Phys 1993;26:43–9.22. Willams V., Denekemp J., Fowler J.F. A review of α/β ratios for experimental tumours: Implications for clinical studies of altered fractionation. Int J Radiat Oncol Biol Phys 1985;11:87–96.Willams V., Denekemp J., Fowler J.F. A review of α/β ratios for experimental tumours: Implications for clinical studies of altered fractionation. Int J Radiat Oncol Biol Phys 1985;11:87–96.23. Cosset J.M. Hypofractionnement en radiotherapies: Le retour? Cancer Radiother 2005;9:366–73.Cosset J.M. Hypofractionnement en radiotherapies: Le retour? Cancer Radiother 2005;9:366–73.24. Buchholz T.A., Austin-Seymour M.M., Moe R.E. et al. Effect of delay in radiation in the combined modality treatment of breast cancer. Int J Radiat Oncol Biol Phys 1993;26:23–35.Buchholz T.A., Austin-Seymour M.M., Moe R.E. et al. Effect of delay in radiation in the combined modality treatment of breast cancer. Int J Radiat Oncol Biol Phys 1993;26:23–35.25. Hall E.J., Giaccia A.J. Radiobiology for the radiologist. Philadelphia PA: Lippincott Williams & Wilkins, 2006.Hall E.J., Giaccia A.J. Radiobiology for the radiologist. Philadelphia PA: Lippincott Williams & Wilkins, 2006.26. Yarnold J., Bentzen S.M., Coles C. Hypofractionated whole-breast radiotherapy for the women with early breast cancer: myths and realities. Int J Radiat Oncol Biol Phys 2011;79(1):1–9.Yarnold J., Bentzen S.M., Coles C. Hypofractionated whole-breast radiotherapy for the women with early breast cancer: myths and realities. Int J Radiat Oncol Biol Phys 2011;79(1):1–9.27. Thames H.D., Bentzen S.M., Turesson I. et al. Time-dose factors in radiotherapy: A review of the human data. Radiother Oncol 1990;19:219–35.Thames H.D., Bentzen S.M., Turesson I. et al. Time-dose factors in radiotherapy: A review of the human data. Radiother Oncol 1990;19:219–35.28. Bentzen S.M., Agrawal R.K., Aird E.G. et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008;371(9618):1098–107.Bentzen S.M., Agrawal R.K., Aird E.G. et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet 2008;371(9618):1098–107.29. Bentzen S.M., Agrawal R.K., Aird E.G. et al. The UK Standardization of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet Oncol 2008;9(4):331–41.Bentzen S.M., Agrawal R.K., Aird E.G. et al. The UK Standardization of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet Oncol 2008;9(4):331–41.30. Bentzen S.M., Turesson I., Thames H.D. Fractionation sensitivity and latency of telangiectasia after postmastectomy radiotherapy: A graded-response analysis. Radiother Oncol 1990;18:95–106.Bentzen S.M., Turesson I., Thames H.D. Fractionation sensitivity and latency of telangiectasia after postmastectomy radiotherapy: A graded-response analysis. Radiother Oncol 1990;18:95–106.31. Fowler J.F. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 1989;62:679–94.Fowler J.F. The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 1989;62:679–94.32. Jones B., Dale R.G., Deehan C. et al. The role of biologically effective dose (BED) in clinical oncology. Clin Oncol (R Coll Radiol) 2001;13:71–81.Jones B., Dale R.G., Deehan C. et al. The role of biologically effective dose (BED) in clinical oncology. Clin Oncol (R Coll Radiol) 2001;13:71–81.33. Miles E.F., Lee W.R. Hypofractionation for prostate cancer: A critical review. Semin Radiat Oncol 2008;18:41–7.Miles E.F., Lee W.R. Hypofractionation for prostate cancer: A critical review. Semin Radiat Oncol 2008;18:41–7.34. Thames H.D., Bentzen S.M., Turesson I. et al. Fractionation parameters for human tissues and tumors. Int J Radiat Biol 1989;56:701–10.Thames H.D., Bentzen S.M., Turesson I. et al. Fractionation parameters for human tissues and tumors. Int J Radiat Biol 1989;56:701–10.35. Withers H.R., Thames H.D. Jr., Peters L.J. A new isoeffect curve for change in dose per fraction. Radiother Oncol 1983;1:187–91.Withers H.R., Thames H.D. Jr., Peters L.J. A new isoeffect curve for change in dose per fraction. Radiother Oncol 1983;1:187–91.36. Whelan T.J., Pignol J.P., Levine M.N. et al. Longterm results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010;362(6):513–20.Whelan T.J., Pignol J.P., Levine M.N. et al. Longterm results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010;362(6):513–20.37. Yarnold J., Ashton A., Bliss J. et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: Long-term results of a randomized trial. Radiother Oncol 2005;75:9–17.Yarnold J., Ashton A., Bliss J. et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: Long-term results of a randomized trial. Radiother Oncol 2005;75:9–17.38. Hopwood P., Haviland J.S., Sumo G. et al. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol 2010;11(7):612–3.Hopwood P., Haviland J.S., Sumo G. et al. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol 2010;11(7):612–3.39. Whelan T.J., Kim D.H., Sussman J. Clinical experience using hypofractionated radiation schedules in breast cancer. Semin Radiat Oncol 2008;18(4):257–64.Whelan T.J., Kim D.H., Sussman J. Clinical experience using hypofractionated radiation schedules in breast cancer. Semin Radiat Oncol 2008;18(4):257–64.40. Holloway C.L., Panet-Raymond V., Olivotto I. Hypofractionation should be the new ‘standard’ for radiation therapy after breast conserving surgery. Breast 2010;19:163–7.Holloway C.L., Panet-Raymond V., Olivotto I. Hypofractionation should be the new ‘standard’ for radiation therapy after breast conserving surgery. Breast 2010;19:163–7.41. Mannino M., Yarnold J.R. Local relapse rates are falling after breast-conserving surgery and systemic therapy for early breast cancer: Can radiotherapy ever be safely withheld? Radiother Oncol 2009;90:14–22.Mannino M., Yarnold J.R. Local relapse rates are falling after breast-conserving surgery and systemic therapy for early breast cancer: Can radiotherapy ever be safely withheld? Radiother Oncol 2009;90:14–22.42. James M.L., Lehman M., Hider P.N. et al. Fraction size in radiation treatment for breast conservation in early breast cancer. Cochrane Database Syst Rev 2008;3(3):CD003860.James M.L., Lehman M., Hider P.N. et al. Fraction size in radiation treatment for breast conservation in early breast cancer. Cochrane Database Syst Rev 2008;3(3):CD003860.43. Lind P.A., Wennberg B., Gagliardi G. et al. ROC curves and evaluation of radiation- induced pulmonary toxicity in breast cancer. Int J Radiat Oncol Biol Phys 2006;64:765–70.Lind P.A., Wennberg B., Gagliardi G. et al. ROC curves and evaluation of radiation- induced pulmonary toxicity in breast cancer. Int J Radiat Oncol Biol Phys 2006;64:765–70.44. McGale P., Darby S.C. Low doses of ionizing radiation and circulatory diseases: A systematic review of the published epidemiological evidence. Radiat Res 2005;163:247–57.McGale P., Darby S.C. Low doses of ionizing radiation and circulatory diseases: A systematic review of the published epidemiological evidence. Radiat Res 2005;163:247–57.45. Rancati T., Wennberg B., Lind P. et al. Early clinical and radiological pulmonary complications following breast cancer radiation therapy: NTCP fit with four different models. Radiother Oncol 2007;82:308–16.Rancati T., Wennberg B., Lind P. et al. Early clinical and radiological pulmonary complications following breast cancer radiation therapy: NTCP fit with four different models. Radiother Oncol 2007;82:308–16.46. Taylor C.W., Nisbet A., McGale P. et al. Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Radiat Oncol Biol Phys 2007;69:1484–95.Taylor C.W., Nisbet A., McGale P. et al. Cardiac exposures in breast cancer radiotherapy: 1950s–1990s. Int J Radiat Oncol Biol Phys 2007;69:1484–95.47. Hebert-Croteau N., Freeman C.R., Latreille J. et al. Delay in adjuvant radiation treatment and outcomes of breast cancer — A review. Breast Cancer Res Treat 2002;74:77–94.Hebert-Croteau N., Freeman C.R., Latreille J. et al. Delay in adjuvant radiation treatment and outcomes of breast cancer — A review. Breast Cancer Res Treat 2002;74:77–94.48. Huang J., Barbera L., Brouwers M. et al. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003;21:555–63.Huang J., Barbera L., Brouwers M. et al. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003;21:555–63.49. Fehlauer F., Tribius S., Alberti W., Rades D. Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy. Strahlenther Onkol 2005;181(10):625–31.Fehlauer F., Tribius S., Alberti W., Rades D. Late effects and cosmetic results of conventional versus hypofractionated irradiation in breast-conserving therapy. Strahlenther Onkol 2005;181(10):625–31.50. Bartelink H., Arriagada R. Hypofractionation in radiotherapy for breast cancer. Lancet 2008;371:1050–2.Bartelink H., Arriagada R. Hypofractionation in radiotherapy for breast cancer. Lancet 2008;371:1050–2.51. Dewar J.A. Hypofractionation for early breast cancer: first results of the UK standardization of radiotherapy (START) trials. J Ctin Oncol 2007;25(18):964.Dewar J.A. Hypofractionation for early breast cancer: first results of the UK standardization of radiotherapy (START) trials. J Ctin Oncol 2007;25(18):964.52. Nguyen P.L., Taghian A.G., Katz M.S. et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and Her-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 2008;26:2373–8.Nguyen P.L., Taghian A.G., Katz M.S. et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and Her-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 2008;26:2373–8.53. Nuyten D.S., Kreike B., Hart A.A. et al. Predicting a local recurrence after breast- conserving therapy by gene expression profiling. Breast Cancer Res 2006;8:62.Nuyten D.S., Kreike B., Hart A.A. et al. Predicting a local recurrence after breast- conserving therapy by gene expression profiling. Breast Cancer Res 2006;8:62.54. Sørlie T., Perou C.M., Tibshirani R. et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 2001;98:10869–74.Sørlie T., Perou C.M., Tibshirani R. et al. Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 2001;98:10869–74.55. Haviland J.S., Yarnold J.R., Bentzen S.M. Hypofractionated radiation therapy for high-grade breast cancer. N Engl J Med 2010;362(19):1843–4.Haviland J.S., Yarnold J.R., Bentzen S.M. Hypofractionated radiation therapy for high-grade breast cancer. N Engl J Med 2010;362(19):1843–4.56. Moody A.M., Mayles W.P., Bliss J.M. et al. The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 1994;33:106–12.Moody A.M., Mayles W.P., Bliss J.M. et al. The influence of breast size on late radiation effects and association with radiotherapy dose inhomogeneity. Radiother Oncol 1994;33:106–12.57. Olivotto I.A., Weir L.M., Kim-Sing C. et al. Late cosmetic results of short fractionation for breast conservation. Radiother Oncol 1996;41:7–13.Olivotto I.A., Weir L.M., Kim-Sing C. et al. Late cosmetic results of short fractionation for breast conservation. Radiother Oncol 1996;41:7–13.58. Freedman G.M., Anderson P.R., Goldstein L.J. et al. Four-week course of radiation for breast cancer using hypofractionated intensity modulated radiation therapy with an incorporated boost. Int J Radiat Oncol Biol Phys 2007;68:347–53.Freedman G.M., Anderson P.R., Goldstein L.J. et al. Four-week course of radiation for breast cancer using hypofractionated intensity modulated radiation therapy with an incorporated boost. Int J Radiat Oncol Biol Phys 2007;68:347–53.