Is there an age cutoff you use to determine when you will offer standard vs hypofractionated breast radiation in early stage breast cancer?   

About 20% of patients in both START A and START B were under the age of 50, and these were huge trials. As such, I don't see a compelling reason not to treat younger women with hypofractionation. To put it another way, I don't think we have good reason to believe that schedules that are designed t...

I agree. Not only was there no significant difference in locoregional control between regimens in START B (the HR for LRR was actually 0.77 for the 40 Gy regimen compared to the 50Gy regimen, p=0.21), but the reduction in late normal tissue effects including breast shrinkage, induration, edema, and ...

The new ASTRO guideline on Radiation therapy for the whole breast has just been published on line in Practical Radiation Oncology (PRO). With a 93% consensus, the panel indicated that hypo-fractionated radiation may be used regardless of age. The discussion notes that followup data on hypo-fractiona...

There isn't a good reason to use age as a cut off, especially based on the evidence.25% of the patients on the Canadian trial were under 50, and they did just as well as the older patients. In fact, their hazard ratio for local recurrence was lower (0.77 vs 1.02), so they may actually do better than...

I have used 50 as the general cutoff, but I will make exceptions for younger women if they need to be finished sooner.  I think the major issue with younger women, is that they often require chemo, and I do not like the hypofractionated schedule in that situation.