Is dose fractionation still relevant?

Radiotherapy is typically delivered as a series of daily fractions that build up to a therapeutic dose over several weeks of treatment. The premise for such fractionation lies in the “four Rs” of radiobiology: repair, repopulation, reoxygenation and redistribution. But is this fractionated approach still relevant in light of today’s precision image-guided radiation dose delivery? This was the question posed by Peter Hoskin, from Mount Vernon Cancer Centre and University College London, at the recent ESTRO 35 conference in Turin, Italy.