ASTRO has published evidence-based guidelines to define appropriate fractionation of whole-breast irradiation. The guidelines state that hypofractionated whole-breast irradiation is effective for patients with early-stage breast cancer who meet certain criteria, including age 50 years and older and stage T1-2 N0 disease. Also, eligible patients will not have received chemotherapy. In addition, the radiation oncologist must be able to provide a relatively uniform delivery of the radiation dose and the ability to exclude the heart from the path of the radiation beam.
For patients who do not meet these criteria, there was not enough evidence to reach a consensus for or against the use of hypofractionated whole-breast irradiation (Int J Radiat Oncol Biol Phys online, July 15, 2010).