Limitations of the current study include the small sample size and its retrospective nature. Our institution is an NCCN member that establishes institutional guidelines across three national sites and may, therefore, stand as an outlier among national RT providers. There are additional scenarios beyond the scope of this paper, including longer treatment schedules using 1.8 Gy/fraction or lumpectomy cavity boost, or both, which add time, fractions, and expenses. Our institution uses the Radiation Therapy Oncology Group 1005 indications for lumpectomy cavity boost as a guideline, which spares many patients’ additional fractions. Additional studies have evaluated even shorter regimens, delivering five fractions once weekly33 or five fractions in 1 week.34 We understand that practice patterns may vary nationally and have only presented the direct medical costs associated with the four WBRT regimens most applicable to our discussion.

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Overall, the data presented show that it is possible for RT practice patterns to rapidly change in response to new level I evidence. We demonstrate evidence-based practice and adherence to national expert recommendations for the population of women aged ≥50 years with hormone receptor-positive, early-stage breast cancer. Millions of potential savings in the health care system could be achieved by practicing evidence-based medicine and following national guidelines for RT in early-stage breast cancer. More importantly, shorter treatment schedules and omission of WBRT in selected patients do not compromise oncologic outcomes and have the immeasurable benefit of avoiding weeks of potentially unnecessary RT to patients.


We are deeply grateful to Sally Eggleston, MBA, BSRT(T) of Revenue Cycle, Inc (Austin, Texas, USA) for her assistance with our cost assessment. Portions of this manuscript have been published in abstract form: Int J Radiat Oncol Biol Phys. 2015;93(3 Suppl):E12.


The authors report no conflicts of interest in this work.


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Source: Breast Cancer: Targets and Therapy.
Originally published February 9, 2018.