A one-week course of adjuvant regional nodal radiotherapy did not negatively affect patient-reported quality of life compared with a conventional three-week hypofractionated schedule, according to findings from the HYPORT Adjuvant trial.
The analysis, published in Radiotherapy & Oncology in July 2026, examined the interaction between regional nodal irradiation and radiotherapy fractionation among patients receiving adjuvant treatment for breast cancer.
Authors: Santam Chakraborty, Sanjoy Chatterjee, Patricia S., Punita Lal, Rajesh Balakrishnan, Rosina Ahmed, B. Selvamani, Shagun Mishra, Shirley Lewis Salins
Testing a Shorter Course of Breast Radiotherapy
The HYPORT Adjuvant trial is comparing an ultrahypofractionated radiotherapy schedule of 26 Gy delivered over one week with a moderately hypofractionated schedule of 40 Gy delivered over three weeks.
The present analysis focused specifically on whether regional nodal irradiation affected quality-of-life outcomes differently between the two treatment schedules.
Regional nodal irradiation is an important component of adjuvant treatment for selected patients with breast cancer. However, its inclusion can raise concerns about treatment burden, arm symptoms and its broader effect on physical and emotional well-being.
The HYPORT Adjuvant trial therefore evaluated quality of life directly from the patient perspective.
Quality of Life Followed for 18 Months
Patient-reported quality of life was assessed using the EORTC QLQ-C30 and FACT-B questionnaires.
Participants completed the questionnaires at five time points:
- Before radiotherapy
- At the end of radiotherapy
- Six months after treatment
- Twelve months after treatment
- Eighteen months after treatment
Researchers used linear mixed models to compare mean quality-of-life scores over time among patients who received regional nodal irradiation and those who did not.
The analysis included 2,173 evaluable patients, of whom 1,508, or 69.4%, received regional nodal irradiation.
At 18 months, 690 patients completed the EORTC QLQ-C30 questionnaire, while 686 completed the FACT-B assessment.
Nearly Identical Global Quality-of-Life Scores
The interaction between treatment allocation and regional nodal irradiation showed no meaningful effect on global quality of life.
The interaction coefficient for the EORTC QLQ-C30 global quality-of-life scale was −0.36, with a 95% confidence interval ranging from −3.1 to 2.4 and a p value of 0.8.
Among patients receiving regional nodal irradiation, the estimated global quality-of-life score at 18 months was:
- 71.75 in the three-week control group
- 71.80 in the one-week experimental group
The difference was not statistically significant, with a p value of 0.969.
The almost identical scores indicate that shortening the radiotherapy course from three weeks to one week did not compromise patients’ overall quality of life when regional lymph nodes were included in the treatment field.
Functional and Symptom Outcomes Remained Comparable
The findings were consistent across the broader quality-of-life assessment.
No differences were observed between the ultrahypofractionated and moderately hypofractionated groups in the other functional or symptom scales evaluated during the 18-month follow-up period.
The study also found no detrimental interaction between regional nodal irradiation and the one-week radiotherapy schedule.
These results suggest that the shorter regimen did not produce an additional burden across the measured physical, functional and symptom-related quality-of-life domains.
Arm Swelling and Tenderness Did Not Increase
Arm-related symptoms are an important concern following regional nodal treatment.
At 18 months, significant arm swelling and tenderness were reported by:
- 23 of 303 patients, or 7.6%, receiving regional nodal irradiation in the three-week control group
- 19 of 330 patients, or 5.7%, receiving regional nodal irradiation in the one-week experimental group
The reported rates did not indicate greater arm-related symptoms with the ultrahypofractionated schedule.
A Shorter Schedule Without a Quality-of-Life Trade-Off
The HYPORT Adjuvant trial findings show that regional nodal irradiation delivered through a one-week ultrahypofractionated schedule did not result in worse patient-reported quality of life than radiotherapy delivered over three weeks.
Global quality-of-life scores remained comparable, functional and symptom outcomes were similar, and no harmful interaction was identified between regional nodal treatment and the shorter fractionation schedule.
For patients requiring adjuvant breast and regional nodal radiotherapy, the findings demonstrate that a substantially shorter treatment course can be delivered without an observed quality-of-life disadvantage during the first 18 months after treatment.
Written by Nare Hovhannisyan, MD
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