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Is it time to re-evaluate the timing of radiation and chemotherapy with the adoption of hypofractionated courses of radiation for breast cancer?

Historically, chemotherapy has been delivered prior to radiation for breast cancer patients requiring it. With the acceptance of shorter courses of radiation treatment, is there a rationale for continuing this approach?
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Radiation Oncology · Beth Israel Deaconess Medical Center
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Clinicians began treating patients commonly with both RT and chemotherapy (CT) in the 1970s and 1980s. They tried many approaches, including giving RT first; giving all CT first; giving a "sandwich" of several cycles of CT, then RT, then completing CT; and giving concurrent RT and CT, with RT starte...

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Radiation Oncology · Varian Medical Systems/Allegheny health network
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I feel one situation where it needs to be addressed with discussion is for patients suitable for APBI as we use it for wider indications and need to be done before RT.

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Radiation Oncology · Rutgers Robert Wood Johnson Medical School
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Yes, I believe hypofractionation has been introduced considering radiation prior to systemic therapy. Particularly when testing workups for systemic therapy can take some time. We are currently doing a trial where the boost of radiation is given preoperative and whole breast in just 11 fractions is ...

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