Hypofractionation-delivering fewer, higher-dose radiotherapy sessions-has transformed cancer care by enhancing treatment quality and optimizing resource efficiency. Enabled by precision technologies like stereotactic body radiotherapy (SBRT) and intensity-modulated radiotherapy (IMRT), this approach achieves non-inferior tumor control for breast, prostate, and lung cancers, supported by landmark trials (e.g., CHHiP, FAST-Forward). Hypofractionation exploits radiobiology, particularly for tumors with low alpha/beta ratios (e.g., prostate cancer), where higher per-fraction doses improve therapeutic efficacy. While acute toxicity (e.g., skin reactions) may rise slightly, late toxicity remains comparable to conventional regimens when advanced techniques minimize damage to healthy tissues.
For patients, hypofractionation improves quality of life by shortening treatment duration (e.g., 1–5 weeks vs. 6–8 weeks), reducing logistical burdens, and increasing accessibility for rural or underserved populations. From a healthcare perspective, fewer sessions lower costs (e.g., ~30% savings in breast cancer), increase machine throughput, and expand capacity, particularly in resource-limited settings. Palliative applications, such as single-fraction bone metastasis treatment, further highlight its efficiency without compromising outcomes.
Challenges include patient selection (avoiding tumors near critical organs), technological disparities limiting global access, and insufficient long-term data for ultra-hypofractionated regimens (e.g., 5-session prostate SBRT). Future priorities involve expanding indications (e.g., pancreatic/liver cancers), integrating immunotherapy to leverage synergistic effects, and promoting equitable adoption through cost-effective protocols and training.
In summary, hypofractionation represents a paradigm shift toward value-based oncology, balancing clinical efficacy with patient-centered and resource-efficient care. While its adoption addresses escalating cancer burdens, equitable implementation and ongoing research remain critical to refine applications and address evidence gaps.
