European Society for Radiotherapy and Oncology Advisory Committee in Radiation Oncology Practice consensus recommendations on patient selection and dose and fractionation for external beam radiotherapy in early breast cancer

High-quality randomised clinical trials testing moderately fractionated breast radiotherapy have clearly shown that
local control and survival is at least as effective as with 2 Gy daily fractions with similar or reduced normal tissue
toxicity. Fewer treatment visits are welcomed by patients and their families, and reduced fractions produce substantial
savings for health-care systems. Implementation of hypofractionation, however, has moved at a slow pace. The
oncology community have now reached an inflection point created by new evidence from the FAST-Forward five-
fraction randomised trial and catalysed by the need for the global radiation oncology community to unite during the
COVID-19 pandemic and rapidly rethink hypofractionation implementation. The aim of this paper is to support
equity of access for all patients to receive evidence-based breast external beam radiotherapy and to facilitate the
translation of new evidence into routine daily practice. The results from this European Society for Radiotherapy and
Oncology Advisory Committee in Radiation Oncology Practice consensus state that moderately hypofractionated
radiotherapy can be offered to any patient for whole breast, chest wall (with or without reconstruction), and nodal
volumes. Ultrafractionation (five fractions) can also be offered for non-nodal breast or chest wall (without
reconstruction) radiotherapy either as standard of care or within a randomised trial or prospective cohort. The
consensus is timely; not only is it a pragmatic framework for radiation oncologists, but it provides a measured
proposal for the path forward to influence policy makers and empower patients to ensure equity of access to evidence-
based radiotherapy.