Fractionation Concepts

Part of the Medical Radiology book series (MEDRAD)


This chapter summarizes the principles of fractionated radiotherapy and altered fractionation approaches. We also provide clinical reirradiation examples and isoeffect calculations. The vast majority of published reirradiation series consist of retrospective data or small prospective studies with limited statistical power. In addition, the typical patient populations are more heterogeneous than in first-line radiotherapy studies. For example, patients with local relapse, regional relapse, or second primary tumors might be included. Therefore, the level of evidence is not comparable to that of first-line radiotherapy, where many treatment recommendations and guidelines rely on large and well-designed prospective randomized trials or meta-analyses of several trials. Reirradiation is often used to palliative symptoms, but occasionally a curative approach, which requires high cumulative radiation doses, is possible and should be offered. A key consideration is to apply high precision radiotherapy techniques. Hyperfractionated reirradiation might theoretically improve the therapeutic ratio, but prospective trials are required to confirm this hypothesis. Many recent studies actually relied on more convenient hypofractionated regimens.


Rectal Cancer Late Toxicity Biologically Effective Dose Fractionation Regimen Hyperfractionated Radiotherapy 
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© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Oncology and Palliative MedicineNordland HospitalBodøNorway
  2. 2.Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
  3. 3.OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav CarusTechnische Universität Dresden, Helmholtz-Zentrum Dresden – RossendorfDresdenGermany
  4. 4.Helmholtz-Zentrum Dresden – Rossendorf, Institute od RadiooncologyDresdenGermany
  5. 5.Deutsches Konsortium für Translationale Krebsforschung (DKTK)Dresden und Deutsches Krebsforschungszentrum (DKFZ)HeidelbergGermany
  6. 6.National Center for Tumor Diseases (NCT)Partner Site DresdenDresdenGermany

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