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The Critical Role of Dose Homogeneity in Modern Breast Hypofractionation.

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Title: The Critical Role of Dose Homogeneity in Modern Breast Hypofractionation.
Authors: Sourial, Fady1 (AUTHOR), Champ, Colin1 (AUTHOR), Beriwal, Sushil1 (AUTHOR) sushil.beriwal@ahn.org
Source: International Journal of Radiation Oncology, Biology, Physics. Jul2026, Vol. 125 Issue 4, p1059-1070. 12p.
Subjects: Homogeneity, Radiotherapy treatment planning, Medical dosimetry, Treatment effectiveness, Breast tumors, Radiotherapy, Therapeutics, Dose fractionation
Abstract: The evolution of breast cancer radiation therapy has witnessed a paradigm shift from conventional fractionation to hypofractionation and now ultrahypofractionation, with multiple randomized trials demonstrating noninferiority in both disease control and cosmetic outcomes. A central, yet underemphasized, determinant of this success is plan optimization by dose homogeneity. As fraction size increases, the biological impact of dose heterogeneity becomes magnified, making volumetric control of high-dose regions essential for both cosmesis and reducing late effects. This comprehensive review traces the progression from 2-dimensional central axis prescriptions to 3-dimensional volumetric optimization, examining how technological advances have enabled safe delivery of larger fraction sizes, partially through the ability to improve dose homogeneity. Dosimetric parameters across landmark trials have shown the importance of dose homogeneity, and metrics such as V105% <5% to 10%, V107% <2%, and maximum dose <110% are critical for successful hypofractionation. The evidence reveals that breast size, not fractionation schedule, drives cosmetic risk when homogeneity is optimized. We provide practical recommendations for achieving these standards using modern planning techniques, emphasizing that dose homogeneity must be considered a fundamental requirement, not a secondary endpoint, in contemporary breast radiation therapy. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Engineering Source
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Header DbId: egs
DbLabel: Engineering Source
An: 194732753
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
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  Data: The evolution of breast cancer radiation therapy has witnessed a paradigm shift from conventional fractionation to hypofractionation and now ultrahypofractionation, with multiple randomized trials demonstrating noninferiority in both disease control and cosmetic outcomes. A central, yet underemphasized, determinant of this success is plan optimization by dose homogeneity. As fraction size increases, the biological impact of dose heterogeneity becomes magnified, making volumetric control of high-dose regions essential for both cosmesis and reducing late effects. This comprehensive review traces the progression from 2-dimensional central axis prescriptions to 3-dimensional volumetric optimization, examining how technological advances have enabled safe delivery of larger fraction sizes, partially through the ability to improve dose homogeneity. Dosimetric parameters across landmark trials have shown the importance of dose homogeneity, and metrics such as V105% &lt;5% to 10%, V107% &lt;2%, and maximum dose &lt;110% are critical for successful hypofractionation. The evidence reveals that breast size, not fractionation schedule, drives cosmetic risk when homogeneity is optimized. We provide practical recommendations for achieving these standards using modern planning techniques, emphasizing that dose homogeneity must be considered a fundamental requirement, not a secondary endpoint, in contemporary breast radiation therapy. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
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  Data: &lt;i&gt;Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=egs&AN=194732753
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1016/j.ijrobp.2026.01.005
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 12
        StartPage: 1059
    Subjects:
      – SubjectFull: Homogeneity
        Type: general
      – SubjectFull: Radiotherapy treatment planning
        Type: general
      – SubjectFull: Medical dosimetry
        Type: general
      – SubjectFull: Treatment effectiveness
        Type: general
      – SubjectFull: Breast tumors
        Type: general
      – SubjectFull: Radiotherapy
        Type: general
      – SubjectFull: Therapeutics
        Type: general
      – SubjectFull: Dose fractionation
        Type: general
    Titles:
      – TitleFull: The Critical Role of Dose Homogeneity in Modern Breast Hypofractionation.
        Type: main
  BibRelationships:
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      – PersonEntity:
          Name:
            NameFull: Sourial, Fady
      – PersonEntity:
          Name:
            NameFull: Champ, Colin
      – PersonEntity:
          Name:
            NameFull: Beriwal, Sushil
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          Dates:
            – D: 15
              M: 07
              Text: Jul2026
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 03603016
          Numbering:
            – Type: volume
              Value: 125
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: International Journal of Radiation Oncology, Biology, Physics
              Type: main
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