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• W2015522433 abstract "Carling and colleagues raise a number of points to be addressed and set into context. Many of their comments relate to radiotherapy schedules and practices that were used many years ago and do not take into account advances in treatment and radiobiological knowledge that have occurred since then. In our reports of the START trials 1 The 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; 9: 331-341 Summary Full Text Full Text PDF PubMed Scopus (867) Google Scholar , 2 The START Trialists' GroupThe UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008; 371: 1098-1107 Summary Full Text Full Text PDF PubMed Scopus (924) Google Scholar , 3 Hopwood P Haviland JS Sumo G Mills JM Bliss JB Yarnold JR Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol. 2010; 11: 231-240 Summary Full Text Full Text PDF PubMed Scopus (173) Google Scholar we stated that, while the absolute rates of some late side-effects of radiation increase with time, the relative effects of different fractionation schedules do not, as shown in the START pilot study (median follow-up 10 years). 4 Yarnold J Ashton A Bliss J et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol. 2005; 75: 9-17 Summary Full Text Full Text PDF PubMed Scopus (411) Google Scholar Although in the past there was substantial morbidity associated with hypofractionated schedules, this occurred before it was recognised that the total dose needed to be lowered to compensate for larger fractions, as we did in the START trials. 5 Thames Jr, HD Withers HR Peters LJ Fletcher GH Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys. 1982; 8: 219-226 Summary Full Text PDF PubMed Scopus (704) Google Scholar , 6 Fowler JF Review: total doses in fractionated radiotherapy-implications of new radiobiological data. Int J Radiat Biol Relat Stud Phys Chem Med. 1984; 46: 103-120 Crossref PubMed Scopus (100) Google Scholar Moreover, major improvements in the accuracy of radiotherapy planning and delivery over the years, helped by radiotherapy quality assurance programmes within trials, have contributed to reduced rates of adverse effects with far fewer severe reactions than before. 7 Venables K Miles EA Deighton A Aird EGA Hoskin PJ Irradiation of the heart during tangential breast treatment: a study within the START trial. Br J Radiol. 2004; 77: 137-142 Crossref PubMed Scopus (17) Google Scholar Quality of life after breast radiotherapyWe have long awaited the report of the quality of life study from the START trials by Hopwood and colleagues,1 but we are surprised at the conclusions drawn by the authors. Full-Text PDF" @default.
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• W2015522433 date "2010-07-01" @default.
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• W2015522433 title "Quality of life after breast radiotherapy – Authors' reply" @default.
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