In the field of oncology, we are fortunate to possess a vast and ever-expanding trove of knowledge, and we now have a sufficient foundation of knowledge in many cancers to afford ourselves the luxury of striving to seek wisdom as well.
The management of rectal cancer in patients with metastatic disease at presentation is highly variable. Although chemoradiation is standard for patients with stage II/III rectal cancer, its role in the metastatic setting is controversial.
In this review we discuss the rationale and underlying radiobiologic concepts for hypofractionation, and review the clinical trials and ASTRO guidelines supporting hypofractionated radiation in the treatment of breast cancer.
Customized more aggressive treatments should be given to patients with the worst prognosis. For most of the other breast patients, shorter and often milder treatment is also a humble victory in our daily struggle against cancer.
There is a need to learn more about the effect of hypofractionation on an individual patient’s breast cancer outcomes and tissue toxicities, based on both biologic and technical variables, so that the treatment decision is not primarily a matter of dollars and cents.