Do you avoid hypofractionated regimen for Grade 3 early stage breast cancer?  

The Canadian finding was unexpected and likely not reproducible. Not sure if it will hold up in longer follow-up. START did not find that and I would not withhold hypofractionation based on grade. Whether the boost makes a difference based on grade is pure speculation at this point, but I tend to bo...

I agree with @Bruce G. Haffty. The initial finding of a higher cumulative incidence of local recurrence with hypofractionation in high grade tumors was an unplanned subset analysis using the Scharff Bloom Richardson grading system, which is no longer routinely used in clinical practice. Central path...

The new ASTRO guideline on whole breast hypofractionaton recently published in Practical Radiation Oncology concluded with 100% consensus that the decision to offer hypofractionation should be independent of tumor grade.

I agree with the above. At our institution, grade is not considered a factor for not doing hypofractionation based on START A and B and the update of the Whelan data where molecular subtype only, and not grade or use of hypofractionation, predicted for local recurrence. We do add a 10 gy boost at 2....

I do not use grade as a determinant for hypofractionated regimens. I only add a boost when there is a reason, such as close margins.  In those cases I like to use 3 Gy x 3 fractions.