You want 20 year data for hypofractionation? Hahahahaha. And then that shows benefit, and then we need 25 year data? When does it stop? Sheesh ...
ASTRO Guidelines actual text: "It is important to note that this guideline should
not be interpreted to prohibit or oppose the use of HF-WBI for patients not meeting all the criteria listed but rather that the evidence was not sufficient to reach consensus for such patients." They never made an "endorsement"; that's not how the guidelines were to be interpreted, even though community physicians didn't read the whole paper and decided that anyone not meeting that criteria should never be offered hypo-fractionation, and despite the fact that the guidelines are 6 years old and even the authors don't follow them. The lead author, in fact, treats almost every single stage I/II/node negative patient with hypofractionation. We really should focus on the more up to date consensus guidelines. The most recent NCCN guidelines (2016) says it is "preferred" for stage I/II and does not mention age. The ACR Appropriateness Criteria for DCIS (2015) says that for even young woman, HF is given an "8"
As far as grade, there was an
update that showed no difference in outcome based on grade, and the conclusion that all N0 patients can safely be treated with HF.
And, sorry for lack of clarity. No, not a OS benefit for DCIS. But there is for invasive.
I just don't get where the age thing comes from. All the trials included younger patients. They may be the ones that even benefit the most. Less side effects. Possibly more effective. Cheaper. More convenient.