Does hypofractionation increase the risk of complications in women receiving postmastectomy RT after reconstruction? RT CHARM was presented a while back, but here we have the final publication. It was a randomized noninferiority trial that included 825 patients who were planned to have mastectomy, immediate or delayed reconstruction (using implant or autologous techniques), and PMRT for breast cancer. They were randomized to receive 50 Gy in 25 fractions or 42.56 Gy in 16 fractions. At 24 months, the primary endpoint of reconstruction complication rate was noninferior with hypofractionation (12.3% v 10.2%). The real driver of complications (regardless of radiation technique) was implant only reconstruction which had a significantly higher risk of complications than autologous reconstruction. The rate of locoregional recurrence at 36 months was similar between arms (1.5% hypofractionation vs 2.2% conventional fractionation). Finally, there were no significant differences in acute or late adverse effects between arms. | Poppe, J Clin Oncol 2026
