Kefah Mokbel, Professor of Medicine at Cardiff University School of Medicine, shared on LinkedIn:
“From 5 Weeks to 3 Weeks… Are 5 Fractions Next for Postmastectomy Radiotherapy?
The RT CHARM trial (Alliance A221505), published in the Journal of Clinical Oncology, marks another important step towards shorter radiotherapy schedules for women undergoing breast reconstruction.
This phase III randomized trial enrolled 898 women, comparing:
- Hypofractionated PMRT: 42.56 Gy in 16 fractions (3 weeks)
- Conventional PMRT: 50 Gy in 25 fractions (5 weeks)
Key findings:
- Reconstruction complications at 24 months: 12.3% versus 10.2%, demonstrating noninferiority.
- Locoregional recurrence at 36 months: 1.5% versus 2.2%, with no statistically significant difference.
- Acute and late toxicity: No statistically significant differences.
Implant-only reconstruction was associated with higher complication rates than autologous reconstruction, regardless of fractionation schedule.
Are 5 Fractions the Next Frontier?
With RT CHARM supporting three-week PMRT and FAST-Forward providing strong evidence for five-fraction breast and chest-wall radiotherapy, the next important question is whether we can safely move from 15-16 fractions to just 5 fractions in women undergoing breast reconstruction.
Long-term reconstruction outcomes, implant complications, regional nodal irradiation, and late toxicity remain key considerations.
Could a randomized trial comparing 3 weeks versus 1 week be the next step towards establishing five-fraction PMRT in this population?
The future of breast radiotherapy is moving towards shorter, more patient-centred treatment schedules, but each step must remain evidence-based.
Reference: Poppe MM et al. RT CHARM, Journal of Clinical Oncology.”
Title: Randomized Trial of Hypofractionated Postmastectomy Radiation Therapy in Women With Breast Reconstruction (RT CHARM, Alliance A221505)
Authors: Matthew M. Poppe, Jennifer J. Le-Rademacher, Bruce G. Haffty, Eric K. Hansen, Jayant P. Agarwal, Jamie L. Wagner, Iwa Kong, Jane M. Armer, Doug W. Arthur, Timothy J. Whelan, Odum Kour, Minji K. Lee, Kathryn J. Ruddy, Ann H. Partridge, Lisa A. Carey, Maryam Lustberg, Michael B. Bernstein, Selina L. Chow, Shane R. Stecklein, David K. Gaffney, Atif J. Khan
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