The Critical Role of Dose Homogeneity in Modern Breast Hypofractionation

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.