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• W1830334259 abstract "BackgroundThe international standard radiotherapy schedule for early breast cancer delivers 50 Gy in 25 fractions of 2·0 Gy over 5 weeks, but there is a long history of non-standard regimens delivering a lower total dose using fewer, larger fractions (hypofractionation). We aimed to test the benefits of radiotherapy schedules using fraction sizes larger than 2·0 Gy in terms of local-regional tumour control, normal tissue responses, quality of life, and economic consequences in women prescribed post-operative radiotherapy.MethodsBetween 1999 and 2001, 2215 women with early breast cancer (pT1-3a pN0-1 M0) at 23 centres in the UK were randomly assigned after primary surgery to receive 50 Gy in 25 fractions of 2·0 Gy over 5 weeks or 40 Gy in 15 fractions of 2·67 Gy over 3 weeks. Women were eligible for the trial if they were aged over 18 years, did not have an immediate reconstruction, and were available for follow-up. Randomisation method was computer generated and was not blinded. The protocol-specified principal endpoints were local-regional tumour relapse, defined as reappearance of cancer at irradiated sites, late normal tissue effects, and quality of life. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN59368779.Findings1105 women were assigned to the 50 Gy group and 1110 to the 40 Gy group. After a median follow up of 6·0 years (IQR 5·0–6·2) the rate of local-regional tumour relapse at 5 years was 2·2% (95% CI 1·3–3·1) in the 40 Gy group and 3·3% (95% CI 2·2 to 4·5) in the 50 Gy group, representing an absolute difference of −0·7% (95% CI −1·7% to 0·9%)—ie, the absolute difference in local-regional relapse could be up to 1·7% better and at most 1% worse after 40 Gy than after 50 Gy. Photographic and patient self-assessments indicated lower rates of late adverse effects after 40 Gy than after 50 Gy.InterpretationA radiation schedule delivering 40 Gy in 15 fractions seems to offer rates of local-regional tumour relapse and late adverse effects at least as favourable as the standard schedule of 50 Gy in 25 fractions. The international standard radiotherapy schedule for early breast cancer delivers 50 Gy in 25 fractions of 2·0 Gy over 5 weeks, but there is a long history of non-standard regimens delivering a lower total dose using fewer, larger fractions (hypofractionation). We aimed to test the benefits of radiotherapy schedules using fraction sizes larger than 2·0 Gy in terms of local-regional tumour control, normal tissue responses, quality of life, and economic consequences in women prescribed post-operative radiotherapy. Between 1999 and 2001, 2215 women with early breast cancer (pT1-3a pN0-1 M0) at 23 centres in the UK were randomly assigned after primary surgery to receive 50 Gy in 25 fractions of 2·0 Gy over 5 weeks or 40 Gy in 15 fractions of 2·67 Gy over 3 weeks. Women were eligible for the trial if they were aged over 18 years, did not have an immediate reconstruction, and were available for follow-up. Randomisation method was computer generated and was not blinded. The protocol-specified principal endpoints were local-regional tumour relapse, defined as reappearance of cancer at irradiated sites, late normal tissue effects, and quality of life. Analysis was by intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN59368779. 1105 women were assigned to the 50 Gy group and 1110 to the 40 Gy group. After a median follow up of 6·0 years (IQR 5·0–6·2) the rate of local-regional tumour relapse at 5 years was 2·2% (95% CI 1·3–3·1) in the 40 Gy group and 3·3% (95% CI 2·2 to 4·5) in the 50 Gy group, representing an absolute difference of −0·7% (95% CI −1·7% to 0·9%)—ie, the absolute difference in local-regional relapse could be up to 1·7% better and at most 1% worse after 40 Gy than after 50 Gy. Photographic and patient self-assessments indicated lower rates of late adverse effects after 40 Gy than after 50 Gy. A radiation schedule delivering 40 Gy in 15 fractions seems to offer rates of local-regional tumour relapse and late adverse effects at least as favourable as the standard schedule of 50 Gy in 25 fractions. The international standard radiotherapy regimen after breast conservation surgery or mastectomy for early breast cancer delivers 25 daily doses (fractions) of 2·0 Gy to a total dose of 50 Gy over 5 weeks.1Fisher B Redmond C Fisher ER et al.Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.N Engl J Med. 1985; 312: 674-681Crossref PubMed Scopus (1157) Google Scholar, 2van Dongen JA Bartelink H Fentiman IS et al.Randomized clinical trial to assess the value of breast-conserving therapy in stage I and II breast cancer, EORTC 10801 trial.J Natl Cancer Inst Monogr. 1992; 11: 15-18PubMed Google Scholar, 3Veronesi U Luini A Del Vecchio M et al.Radiotherapy after breast-preserving surgery in women with localized cancer of the breast.N Engl J Med. 1993; 328: 1587-1591Crossref PubMed Scopus (677) Google Scholar, 4Fisher B Costantino J Redmond C et al.Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer.N Engl J Med. 1993; 328: 1581-1586Crossref PubMed Scopus (620) Google Scholar Alternative schedules based on a lower total dose delivered in fewer, larger fractions (hypofractionation) were introduced in the UK and Canada several decades ago5Paterson R The treatment of malignant disease by radium and x-rays. First edn. Edward Arnold, London1948Google Scholar on an empirical basis, and 40 Gy in 15 fractions over 3 weeks is a commonly used regimen.5Paterson R The treatment of malignant disease by radium and x-rays. First edn. Edward Arnold, London1948Google Scholar, 6Williams MV James ND Summers ET Barrett A Ash DV National survey of radiotherapy fractionation practice in 2003.Clin Oncol (R Coll Radiol). 2006; 18: 3-14Summary Full Text Full Text PDF PubMed Scopus (57) Google Scholar Results of retrospective studies of hypofractionated radiotherapy in early breast cancer suggest satisfactory outcomes in terms of tumour control and late adverse effects if modest increases in fraction size are combined with appropriate downward adjustments to total dose.7Peters MV Carcinoma of the breast. Stage II—radiation range. Wedge resection and irradiation. An effective treatment in early breast cancer.JAMA. 1967; 200: 134-135Crossref PubMed Scopus (71) Google Scholar, 8Ash DV Benson EA Sainsbury JR Round C Head C Seven-year follow-up on 334 patients treated by breast conserving surgery and short course radical postoperative radiotherapy: a report of the Yorkshire Breast Cancer Group.Clin Oncol (R Coll Radiol). 1995; 7: 93-96Summary Full Text PDF PubMed Scopus (61) Google Scholar, 9Olivotto IA Weir LM Kim-Sing C et al.Late cosmetic results of short fractionation for breast conservation.Radiother Oncol. 1996; 41: 7-13Summary Full Text PDF PubMed Scopus (128) Google Scholar, 10Clark RM Whelan T Levine M et al.Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology Group.J Natl Cancer Inst. 1996; 88: 1659-1664Crossref PubMed Scopus (535) Google Scholar, 11Magee B Stewart AL Swindell R Outcome of radiotherapy after breast conserving surgery in screen detected breast cancers.Clin Oncol (R Coll Radiol). 1999; 11: 40-45Summary Full Text PDF PubMed Scopus (16) Google Scholar, 12Shelley W Brundage M Hayter C Paszat L Zhou S Mackillop W A shorter fractionation schedule for postlumpectomy breast cancer patients.Int J Radiat Oncol Biol Phys. 2000; 47: 1219-1228Summary Full Text Full Text PDF PubMed Scopus (102) Google Scholar, 13McBain CA Young EA Swindell R Magee B Stewart AL Local recurrence of breast cancer following surgery and radiotherapy: incidence and outcome.Clin Oncol (R Coll Radiol). 2003; 15: 25-31Summary Full Text PDF PubMed Scopus (53) Google Scholar, 14Fyles AW McCready DR Manchul LA et al.Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer.N Engl J Med. 2004; 351: 963-970Crossref PubMed Scopus (533) Google Scholar The first results of a Canadian randomised trial testing 42·5 Gy in 16 fractions against 50 Gy in 25 fractions are consistent with these findings, suggesting equivalence in terms of local control and breast cosmesis for the 16-fraction regimen.15Whelan T MacKenzie R Julian J et al.Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer.J Natl Cancer Inst. 2002; 94: 1143-1150Crossref PubMed Scopus (553) Google Scholar Fractions of more than 2·0 Gy caused unacceptable rates of late adverse effects when inadequate downward adjustments to total dose were applied several decades ago.16Overgaard M Bentzen SM Christensen JJ Madsen EH The value of the NSD formula in equation of acute and late radiation complications in normal tissue following 2 and 5 fractions per week in breast cancer patients treated with postmastectomy irradiation.Radiother Oncol. 1987; 9: 1-11Summary Full Text PDF PubMed Scopus (111) Google Scholar, 17Rodger A Fears over radiotherapy fractionation regimens in breast cancer. Proposed UK trial needs to define techniques as well as numbers of treatments.BMJ. 1998; 317: 155-156Crossref PubMed Scopus (8) Google Scholar, 18Williams M Inappropriate use of linear-quadratic analysis of tumor response.Int J Radiat Oncol Biol Phys. 1985; 11 (13P6): 1570Summary Full Text PDF PubMed Scopus (7) Google Scholar, 19Dische S Joslin CA Miller S The RAGE litigation. Radiation Action Group Exposure.Lancet. 1998; 351: 1967-1968Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar, 20Yamada Y Ackerman I Franssen E MacKenzie RG Thomas G Does the dose fractionation schedule influence local control of adjuvant radiotherapy for early stage breast cancer?.Int J Radiat Oncol Biol Phys. 1999; 44: 99-104Summary Full Text Full Text PDF PubMed Scopus (58) Google Scholar Despite widespread empirical use in the UK, 40 Gy in 15 fractions has never been formally compared with standard fractionation, raising concerns in the mid-1990s that it could be less effective or less safe than 50 Gy in 25 fractions. To address this uncertainty, the Standardisation of Breast Radiotherapy (START) Trials were initiated by the then UK Coordinating Committee for Cancer Research (now National Cancer Research Institute) to test the effects of radiotherapy schedules using fraction sizes larger than 2·0 Gy. START Trial A21The START Trialists' GroupThe UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial.Lancet Oncol. 2008; (published online March 19.)https://doi.org/10.1016/S1470-2045(08)70077-9Summary Full Text Full Text PDF Scopus (803) Google Scholar tested two dose levels of a 13-fraction regimen delivered over 5 weeks in order to measure the sensitivity of normal and malignant tissues to fraction size. START Trial B compared 40 Gy in 15 fractions of 2·67 Gy in 3 weeks with a control group of 50 Gy in 25 fractions of 2·0 Gy over 5 weeks. This paper presents the results of Trial B. Participation was open to all UK centres that provided radiotherapy treatment to patients with early breast cancer. With START Trials A and B running in parallel, centres chose to participate in either Trial A (17 centres) or B (23 centres). Women with operable invasive breast cancer (International Union Against Cancer stage pT1-3a pN0-1 M0) requiring radiotherapy after primary surgery (breast conserving surgery or mastectomy, with clear tumour margins ≥1 mm) were eligible for the trial if they were aged over 18 years, did not have an immediate reconstruction, and were available for follow-up. Patients from 21 of the centres participating in Trial B were also recruited into the quality of life and health economics studies (health economics data not presented here, baseline quality of life data have been published elsewhere22Hopwood P Haviland J Mills J Sumo G Bliss JM The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial).Breast. 2007; 16: 241-251Summary Full Text Full Text PDF PubMed Scopus (148) Google Scholar). 20 of the centres participating in the quality of life study recruited patients with breast conserving surgery into the photographic assessment of Trial B. Patients from 17 centres also consented to donate a 20 mL blood sample and to complete an associated family history questionnaire (substudy not reported here). The START Trials were approved by the South Thames Multi-Research Ethics Committee in September, 1998, and by the local ethics committees of all participating centres. Written informed consent was obtained for all patients. START Trial B patients were randomised to 50 Gy in 25 fractions over 5 weeks or to 40 Gy in 15 fractions over 3 weeks. Randomisation was arranged via telephone at the Clinical Trials and Statistics Unit at the Institute of Cancer Research (ICR-CTSU), Sutton, UK, where patient details were recorded and treatment was allocated. Randomisation was not blinded. Computer-generated random permuted blocks were used as the method of allocation, with patients stratified by hospital, type of surgery (breast conserving surgery or mastectomy), and intention to give a tumour bed boost dose or not. Use of adjuvant systemic treatment was recorded, with a requirement of at least a 2-week gap between exposure to chemotherapy and radiotherapy. Patients lay in a supine treatment position. The planning target volume was defined as the whole breast with a 1 cm margin to palpable breast tissue; where regional radiotherapy was indicated, the planning target volume was supraclavicular nodes with or without axillary chain with a 1 cm margin. Most patients were treated with 6 MV x-rays, although treatment with higher energies or cobalt γ-rays was allowed after discussion with the START Trial radiotherapy quality assurance team. Planning protocols were specified at the time of notification of participation into the study and had to conform to the minimum quality criteria described in the protocol. Planning protocols varied slightly between centres, but within each centre they were identical in each fractionation group. Doses were prescribed to international reference points.23ICRU. Prescribing, recording and reporting photon beam therapy. Bethsada: Interantional Commission on Radiation Units and Measurements (ICRU), 1999: Report 62. Supplement to ICRU Report 50.Google Scholar Departments were required to have a protocol specifying whether patients who had had breast conserving surgery would receive a boost to the tumour bed, and to use an electron field of appropriate energy to deliver 10 Gy in five daily fractions to the 100% isodose, after initial radiotherapy. All centres submitted details of the standard radiotherapy technique, after which a visit by the quality assurance team checked dosimetric measurements in a 2D and 3D breast phantom, including the junction region between supraclavicular fossa and tangential breast or chest wall fields.24Venables K Winfield E Deighton A Aird E Hoskin P Breast radiotherapy phantom design for the START trial. START trial management group.Br J Radiol. 2000; 73: 1313-1316Crossref PubMed Scopus (14) Google Scholar, 25Venables K Winfield E Deighton A Aird E Hoskin P The START trial-measurements in semi-anatomical breast and chest wall phantoms.Phys Med Biol. 2001; 46: 1937-1948Crossref PubMed Scopus (17) Google Scholar, 26Venables K Winfield E Deighton A Aird E Hoskin P A survey of radiotherapy quality control practice in the United Kingdom for the START trial.Radiother Oncol. 2001; 60: 311-318Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar, 27Venables K Winfield EA Aird EG Hoskin PJ Three-dimensional distribution of radiation within the breast: an intercomparison of departments participating in the START trial of breast radiotherapy fractionation.Int J Radiat Oncol Biol Phys. 2003; 55: 271-279Summary Full Text Full Text PDF PubMed Scopus (21) Google Scholar The mean difference between prescribed and measured dose in a phantom was 2·1%. Additionally, a third of the radiotherapy treatment plans were collected and analysed by the quality assurance team to ensure compliance with the protocol in terms of prescription point, dose homogeneity, and lung depth, and a random sample of patients had in-vivo thermoluminescent dosimeter measurements done.28Venables K Miles EA Aird EG Hoskin PJ The use of in vivo thermoluminescent dosimeters in the quality assurance programme for the START breast fractionation trial.Radiother Oncol. 2004; 71: 303-310Summary Full Text Full Text PDF PubMed Scopus (28) Google Scholar, 29Venables K Miles EA Hoskin PJ Aird EG Verification films: a study of the daily and weekly reproducibility of breast patient set-up in the START trial.Clin Oncol (R Coll Radiol). 2005; 17: 337-342Summary Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 30Venables K Miles EA Aird EG Hoskin PJ What is the optimum breast plan: a study based on the START trial plans.Br J Radiol. 2006; 79: 734-739Crossref PubMed Scopus (8) Google Scholar The protocol allowed for a dose variation (in the planning target volume) between 95% and 105% of that at the reference point on the central axis. Lung depth data was obtained by the radiotherapy quality assurance programme, and analysis indicated that most patients had less than 2 cm of lung within the treatment volume. These results confirmed a good compliance with the technical aspects of the trial protocol. The principal endpoints specified in the protocol were local-regional relapse, normal tissue effects, and quality of life. Local-regional tumour relapse was defined as local relapse in breast or chest wall, and regional relapse in ipsilateral axilla or supraclavicular fossa if it had been within an irradiated target volume. Any ipsilateral regional relapse outside the radiotherapy target volume was excluded from the analysis of local-regional relapse. Normal tissue effects in the breast, arm, and shoulder were assessed by photographic comparison with baseline, patient self-reported assessments, and physician assessments. Other endpoints were disease-free and overall survival, second primary cancers, and health economic consequences. Disease-free survival was defined as time to any breast cancer-related event (local-regional or distant relapse, contralateral breast cancer, or death from breast cancer). Data relating to five key breast normal tissue effects from the patient quality of life self-assessments are presented here. Separate papers will present the full analysis of all self-assessments and physician assessments of normal tissue effects, and of quality of life. Cases of ischaemic heart disease, symptomatic rib fracture, and symptomatic lung fibrosis were recorded during follow-up; incidence with and without confirmation of diagnosis (eg, using imaging and further investigation) was included. Brachial plexopathy was reported if damage to the brachial plexus was suspected and the patient had symptoms of pain, parasthesia, numbness, or other sensory symptoms (graded on a 4-point scale). Suspected cases of brachial plexopathy were subject to confirmation by neurophysiological assessment and MRI. Patients were reviewed every year for tumour relapse and radiotherapy-induced normal tissue effects. Clinical data were recorded on pre-printed case report forms and sent to the coordinating clinical trials office at the ICR-CTSU, Sutton, UK. Photographs were taken at baseline (post-surgery and pre-radiotherapy) and then at 2 and 5 years to assess changes to the breast based on change in size, shrinkage, and shape, and scored on a 3-point graded scale. Changes in breast appearance (photographic) were scored by three observers blind to patient identity, treatment allocation, and year of follow-up, and a final agreed score reached by consensus. Breast size and surgical deficit were both defined from the baseline photographs by the same three observers applying 3-point graded scales. Quality of life data were obtained using standardised questionnaires31Aaronson NK Ahmedzai S Bergman B et al.The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.J Natl Cancer Inst. 1993; 85: 365-376Crossref PubMed Scopus (10322) Google Scholar, 32Sprangers MA Groenvold M Arraras JI et al.The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study.J Clin Oncol. 1996; 14: 2756-2768PubMed Google Scholar, 33Hopwood P Fletcher I Lee A Al Ghazal S A body image scale for use with cancer patients.Eur J Cancer. 2001; 37: 189-197Summary Full Text Full Text PDF PubMed Scopus (565) Google Scholar, 34Zigmond AS Snaith RP The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370Crossref PubMed Scopus (30126) Google Scholar at baseline and at 6 months, 1, 2, and 5 years. Post-baseline quality of life questionnaires included an additional four protocol-specific items relating to changes in the affected breast after radiotherapy (skin changes in the area of the affected breast, overall change in breast appearance, firmness to touch of the affected breast, and reduction in size of the affected breast). Of these four items, patients who had had mastectomy only rated change in skin appearance after radiotherapy. Details of the quality of life study protocol and baseline data have been published elsewhere.22Hopwood P Haviland J Mills J Sumo G Bliss JM The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial).Breast. 2007; 16: 241-251Summary Full Text Full Text PDF PubMed Scopus (148) Google Scholar The trial was coordinated by the ICR-CTSU, Sutton, UK. The trial was overseen by a Steering Committee of several independent experts joined by members of the ICR-CTSU, START Trial Management Group, and representatives of the funding bodies (as observers). The Trial Management Group was responsible for the day-to-day management of the trial, and the emerging safety and efficacy data was reviewed regularly by the Independent Data Monitoring Committee. Central statistical monitoring of data was done by ICR-CTSU, supplemented by selected on-site source document verification. A 5-year local-regional tumour relapse rate of 10% in the 50 Gy group was predicted, based on the earlier Royal Marsden Hospital/Gloucestershire Oncology Centre (RMH/GOC) pilot trial.35Owen JR Ashton A Bliss JM et al.Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial.Lancet Oncol. 2006; 7: 467-471Summary Full Text Full Text PDF PubMed Scopus (454) Google Scholar A target sample size of 1840 patients was defined in Trial B to provide 95% power to exclude an increase of 5% in the local-regional relapse rate for the 40 Gy group compared with 50 Gy (one-sided α=0·025). The protocol specified that if the true 5-year local-regional relapse rate in the 50 Gy group was lower than expected (eg, 5%), this sample size would give more than 95% power to detect an increase of 5% in the local-regional relapse rate in the 40 Gy group. Survival analysis methods were used to compare rates of each endpoint between the fractionation schedules. Length of follow-up was calculated as time from randomisation until time of first event or last follow-up assessment, whichever occurred first. Patients were still evaluable for local-regional relapse after distant relapse, but were censored at date of death. For the photographic endpoint, patients were no longer evaluable for change in breast appearance after local-regional relapse. Kaplan-Meier estimates of 5-year relapse rates, rates of normal tissue effects, rates of any breast-cancer related event, and mortality rates were calculated (with 95% CIs). For the patient quality of life self-assessments of normal tissue effects an event was defined as the first occurrence of a moderate or marked symptom (graded “quite a bit” or “very much”). The scores from the photographic assessments of change in breast appearance at 2 and 5 years were dichotomised as none versus mild or marked change, and the first occurrence of such a change was taken as the endpoint for the survival analysis. There were too few patients with marked change in breast appearance to be able to analyse this category separately. The log-rank test was used to compare fractionation schedules. Crude hazard ratios (with 95% CIs) comparing fractionation schedules for each endpoint were obtained from Cox proportional hazards regression models. The proportionality assumption of the Cox model was tested using Schoenfeld residuals and was found to be valid for all of the analyses. Since point estimates of differences in event rates can, by chance, be atypical of the overall pattern of differences between schedules, estimates of the absolute difference in 5-year event rates taking the whole range of observation times into account were obtained by applying the hazard ratios obtained from the Cox model to the Kaplan-Meier estimate of the rate in the 50 Gy control group.36Altman DG Andersen PK Calculating the number needed to treat for trials where the outcome is time to an event.BMJ. 1999; 319: 1492-1495Crossref PubMed Scopus (487) Google Scholar Both one-sided and two-sided 95% CIs were calculated for the absolute difference in local-regional relapse rates at 5 years, since the upper limit is of greater clinical interest, in view of concern about a possible excess risk caused by hypofractionated schedules. Kaplan-Meier survival curves and Nelson-Aalen cumulative hazard functions were plotted according to fractionation schedule. Plots were censored at the median length of follow-up (rounded to nearest year). Analysis included all randomised patients on an intention-to-treat basis. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN59368779." @default.
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• W1830334259 title "The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial" @default.
• W1830334259 cites W1848007259 @default.
• W1830334259 cites W1980238854 @default.
• W1830334259 cites W1989085647 @default.
• W1830334259 cites W1999465640 @default.
• W1830334259 cites W2019286628 @default.
• W1830334259 cites W2021741210 @default.
• W1830334259 cites W2023777760 @default.
• W1830334259 cites W2033209427 @default.
• W1830334259 cites W2038660160 @default.
• W1830334259 cites W2040192713 @default.
• W1830334259 cites W2043468165 @default.
• W1830334259 cites W2045166279 @default.
• W1830334259 cites W2046809995 @default.
• W1830334259 cites W2053292907 @default.
• W1830334259 cites W2065048589 @default.
• W1830334259 cites W2071661723 @default.
• W1830334259 cites W2079596097 @default.
• W1830334259 cites W2082400061 @default.
• W1830334259 cites W2089499076 @default.
• W1830334259 cites W2092490429 @default.
• W1830334259 cites W2097823108 @default.
• W1830334259 cites W2103740220 @default.
• W1830334259 cites W2104334285 @default.
• W1830334259 cites W2121603168 @default.
• W1830334259 cites W2123481594 @default.
• W1830334259 cites W2143899676 @default.
• W1830334259 cites W2146357748 @default.
• W1830334259 cites W2156724578 @default.
• W1830334259 cites W2158615473 @default.
• W1830334259 cites W2166281097 @default.
• W1830334259 cites W2167571044 @default.
• W1830334259 cites W2168124422 @default.
• W1830334259 cites W2170907521 @default.
• W1830334259 cites W2318327263 @default.
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