***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Summary Background The international st and ard radiotherapy schedule for early breast cancer delivers 50 Gy in 25 fractions of 2·0 Gy over 5 weeks , but there is a long history of non-st and ard regimens delivering a lower total dose using fewer , larger fractions ( hypofractionation ) . We aim ed to test the benefits of radiotherapy schedules using fraction sizes larger than 2·0 Gy in terms of local-regional tumour control , normal tissue responses , quality of life , and economic consequences in women prescribed post-operative radiotherapy . Methods Between 1999 and 2001 , 2215 women with early breast cancer ( pT1 - 3a pN0 - 1 M0 ) at 23 centres in the UK were r and omly assigned after primary surgery to receive 50 Gy in 25 fractions of 2·0 Gy over 5 weeks or 40 Gy in 15 fractions of 2·67 Gy over 3 weeks . Women were eligible for the trial if they were aged over 18 years , did not have an immediate reconstruction , and were available for follow-up . R and omisation method was computer generated and was not blinded . The protocol -specified principal endpoints were local-regional tumour relapse , defined as reappearance of cancer at irradiated sites , late normal tissue effects , and quality of life . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59368779 . Findings 1105 women were assigned to the 50 Gy group and 1110 to the 40 Gy group . After a median follow up of 6·0 years ( IQR 5·0–6·2 ) the rate of local-regional tumour relapse at 5 years was 2·2 % ( 95 % CI 1·3–3·1 ) in the 40 Gy group and 3·3 % ( 95 % CI 2·2 to 4·5 ) in the 50 Gy group , representing an absolute difference of −0·7 % ( 95 % CI −1·7 % to 0·9%)—ie , the absolute difference in local-regional relapse could be up to 1·7 % better and at most 1 % worse after 40 Gy than after 50 Gy . Photographic and patient self- assessment s indicated lower rates of late adverse effects after 40 Gy than after 50 Gy . Interpretation A radiation schedule delivering 40 Gy in 15 fractions seems to offer rates of local-regional tumour relapse and late adverse effects at least as favourable as the st and ard schedule of 50 Gy in 25 fractions Background and Purpose : Breast irradiation after lumpectomy is an integral component of breast-conserving therapy ( BCT ) . As the prognosis is general good following BCT , late morbidity and cosmesis are important . The present study compares two different radiation schedules with respect to these two endpoints . Patients and Methods : 129 breast cancer patients ( pT1–2 pN0–1 cM0 ) were irradiated between 09/1992 and 08/1994 with either a 22-day fractionation schedule ( 2.5 Gy to 55 Gy , 4 × /week , n = 65 ) or with a conventional fractionation schedule ( 28 days , 2.0 Gy to 55 Gy , 5 × /week , n = 64 ) , both without additional boost . The equivalent dose of 2-Gy fractions ( EQD2 ) was 55 Gy and 62 Gy , respectively . Late toxicity , assessed according to the LENT-SOMA criteria , and cosmetic outcome , grade d on a 5-point scale , were evaluated after a median of 86 months ( range 72–94 months ) in tumor-free breast cancer patients . Results : LENT-SOMA grade 2/3 toxicity ( 2.5 Gy vs. 2.0 Gy ) : breast pain ( 18 % vs. 11 % ; p = 0.3 ) , fibrosis ( 57 % vs. 16 % ; p < 0.001 ) , telangiectasia ( 22 % vs. 3 % ; p = 0.002 ) , atrophy ( 31 % vs. 3 % ; p < 0.001 ) . Medication to breast pain was taken by 8 % versus 9 % of patients . Cosmesis was very good/good/acceptable in 75 % versus 93 % ( 2.5 Gy vs. 2.0 Gy ; p = 0.006 ) . Conclusion : Late morbidity was significantly frequent and cosmesis was significantly worse after hypofractionated radiotherapy ( 2.5 Gy to 55 Gy ) . However , morbidity was not associated with major implication s on daily life . Hintergrund und Ziel : Die adjuvante Bestrahlung der Brust nach Operation ist ein integraler Best and teil der brusterhaltenden Therapie ( BET ) . Da die Prognose nach BET sehr gut ist , stellen die Spättoxizität und Kosmetik wichtige Untersuchungsparameter dar . Die vorliegende Untersuchung vergleicht zwei unterschiedliche Fraktionierungsschemata in Bezug auf diese Endpunkte . Patienten und Method ik:129 Patientinnen mit Brustkrebs ( pT1–2 pN0–1 cM0 ) wurden zwischen 09/1992 und 08/1994 entweder mit einem 22-Tage-Fraktionierungsschema ( 2,5 Gy bis 55 Gy , 4 × /Woche , n = 65 ) oder mit einem 28-Tage-Fraktionierungsschema ( 2,0 Gy bis 55 Gy , 5 × /Woche , n = 64 ) , jeweils ohne Boost , beh and elt . Die Äquivalentdosis für 2 Gy pro Fraktion betrug 55 Gy und 62 Gy . Die Spätnebenwirkungen ( LENT-SOMA ) und das kosmetische Ergebnis ( 5-Punkte-Skala ) wurden erfasst ( mittlere Nachbeobachtungszeit 86 Monate , 72–94 Monate).Ergebnisse : Folgende LENT-SOMA-Nebenwirkungen Grad 2/3 ( 2,5 Gy vs. 2,0 Gy ) traten auf : Brustschmerzen ( 18 % vs. 11 % ; p = 0,3 ) , Fibrose ( 57 % vs. 16 % ; p < 0,001 ) , Teleangiektasien ( 22 % vs. 3 % ; p = 0,002 ) , Atrophie ( 31 % vs. 3 % ; p < 0,001 ) . Schmerzmittel wurden von 8 % versus 9 % der Patientinnen eingenommen . Das kosmetische Ergebnis war sehr gut/gut/moderat in 75 % versus 93 % ( 2,5 Gy vs. 2,0 Gy ; p = 0,006).Schlussfolgerung : Im eigenen Kollektiv ist die Häufigkeit von Spätnebenwirkungen und beeinträchtigter Kosmetik nach hypofraktionierter Strahlentherapie signifikant erhöht , allerdings ohne wesentliche Einschränkungen für den Alltag BACKGROUND 5-year results of the UK St and ardisation of Breast Radiotherapy ( START ) trials suggested that lower total doses of radiotherapy delivered in fewer , larger doses ( fractions ) are at least as safe and effective as the historical st and ard regimen ( 50 Gy in 25 fractions ) for women after primary surgery for early breast cancer . In this prespecified analysis , we report the 10-year follow-up of the START trials testing 13 fraction and 15 fraction regimens . METHODS From 1999 to 2002 , women with completely excised invasive breast cancer ( pT1 - 3a , pN0 - 1 , M0 ) were enrolled from 35 UK radiotherapy centres . Patients were r and omly assigned to a treatment regimen after primary surgery followed by chemotherapy and endocrine treatment ( where prescribed ) . R and omisation was computer-generated and stratified by centre , type of primary surgery ( breast-conservation surgery or mastectomy ) , and tumour bed boost radiotherapy . In START-A , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 41·6 Gy or 39 Gy in 13 fractions over 5 weeks . In START-B , a regimen of 50 Gy in 25 fractions over 5 weeks was compared with 40 Gy in 15 fractions over 3 weeks . Eligibility criteria included age older than 18 years and no immediate surgical reconstruction . Primary endpoints were local-regional tumour relapse and late normal tissue effects . Analysis was by intention to treat . Follow-up data are still being collected . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N59368779 . FINDINGS START-A enrolled 2236 women . Median follow-up was 9·3 years ( IQR 8·0 - 10·0 ) , after which 139 local-regional relapses had occurred . 10-year rates of local-regional relapse did not differ significantly between the 41·6 Gy and 50 Gy regimen groups ( 6·3 % , 95 % CI 4·7 - 8·5 vs 7·4 % , 5·5 - 10·0 ; hazard ratio [ HR ] 0·91 , 95 % CI 0·59 - 1·38 ; p=0·65 ) or the 39 Gy ( 8·8 % , 95 % CI 6·7 - 11·4 ) and 50 Gy regimen groups ( HR 1·18 , 95 % CI 0·79 - 1·76 ; p=0·41 ) . In START-A , moderate or marked breast in duration , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 39 Gy group than in the 50 Gy group . Normal tissue effects did not differ significantly between 41·6 Gy and 50 Gy groups . START-B enrolled 2215 women . Median follow-up was 9·9 years ( IQR 7·5 - 10·1 ) , after which 95 local-regional relapses had occurred . The proportion of patients with local-regional relapse at 10 years did not differ significantly between the 40 Gy group ( 4·3 % , 95 % CI 3·2 - 5·9 ) and the 50 Gy group ( 5·5 % , 95 % CI 4·2 - 7·2 ; HR 0·77 , 95 % CI 0·51 - 1·16 ; p=0·21 ) . In START-B , breast shrinkage , telangiectasia , and breast oedema were significantly less common normal tissue effects in the 40 Gy group than in the 50 Gy group . INTERPRETATION Long-term follow-up confirms that appropriately dosed hypofractionated radiotherapy is safe and effective for patients with early breast cancer . The results support the continued use of 40 Gy in 15 fractions , which has already been adopted by most UK centres as the st and ard of care for women requiring adjuvant radiotherapy for invasive early breast cancer . FUNDING Cancer Research UK , UK Medical Research Council , UK Department of Health BACKGROUND AND METHODS Conservative surgery and radiotherapy have become well-established treatments for breast cancer , and many trials in progress are attempting to define the most acceptable type of procedure . Between 1987 and 1989 we r and omly assigned 567 women with small breast cancers ( < 2.5 cm in diameter ) to quadrantectomy followed by radiotherapy or to quadrantectomy without radiotherapy . All patients underwent total axillary dissection . The median follow-up period was 39 months ( range , 28 to 54 ) . RESULTS The incidence of local recurrence was 8.8 percent among the patients treated with quadrantectomy without radiotherapy , as compared with 0.3 percent among those treated with postsurgical radiotherapy ( P = 0.001 ) . However , there was a substantial effect of age : patients more than 55 years old who did not receive radiotherapy had a low rate of local recurrence ( 3.8 percent ) . The four-year overall survival was similar in the two treatment groups . CONCLUSIONS Administering radiotherapy after quadrantectomy reduces the risk of local recurrence in women with small cancers of the breast , but radiotherapy may not be necessary in elderly women Purpose To evaluate the efficacy and safety of hypofractionated whole-breast irradiation ( HF-WBI ) compared with conventionally fractionated ( CF ) WBI . Material s and methods Patients with early breast cancer ( stages 0–II and <3 positive lymph nodes ) who had undergone breast-conserving surgery were eligible for the HF-WBI study . HF-WBI was administered at 43.2 Gy in 16 fractions over 3.2 weeks to the whole breast with an additional tumor-bed boost of 8.1 Gy in 3 fractions over 3 days for positive surgical margins or those < 5 mm . CF-WBI was administered at 50 Gy in 25 fractions over 5 weeks to the whole breast with an additional tumor-bed boost of 16 Gy in 8 fractions over 1.4 weeks to 6 Gy in 3 fractions over 3 days , depending on margin status . Results From April 1 , 2006 , to December 31 , 2010 , 717 patients were registered and 734 breasts were treated by HF-WBI .  In the same period , 381 patients and 393 breasts who matched the study criteria chose CF-WBI , so the total number of patients 
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Regarding to local regional recurrence , distant metastasis , overall survival , disease free survival , excellent/good cosmetic comes , symptomatic radiation pneumonitis , ischemic heart disease and symptomatic rib fracture , there was no significant difference between two arms .
Based on available evidence , HFRT with 2.5 - 3.0 Gy per fraction should be the better choice for treatment of early breast cancer patients