Results of a national clinical trial led by the Alliance for Clinical Trials in Oncology in conjunction with NRG Oncology and the Canadian Cancer Trials Group show that a shorter, three-week radiation schedule following a mastectomy is as safe and effective as the standard five-week treatment for women undergoing breast reconstruction. The results of the RT CHARM trial ( Alliance A221505 ) are published in the Journal of Clinical Oncology .
For years, doctors have used a shorter radiation approach, known as hypofractionated radiation therapy, for women who have a lumpectomy, surgery that removes the cancerous tumor while preserving the breast. This schedule delivers slightly higher daily doses of radiation per treatment over fewer total visits, reducing the treatment time by nearly half.
However, the use of this shorter approach after mastectomy, which removes the entire breast, has been more limited for women who choose breast reconstruction. Clinicians have been concerned that higher daily radiation doses could increase complications and affect the success of the reconstruction.
“Patients undergoing mastectomy and reconstruction already face a challenging medical journey. Having the evidence to allow women to confidently shorten their radiation treatment from five weeks down to three will save patients time, reduce their financial stress, and let them get back to their daily lives sooner—all without increasing complications, lowering their chances of cure, or sacrificing cosmetic results.” said Matthew M. Poppe, MD, lead author of the study, a radiation oncologist at the Huntsman Cancer Institute at the University of Utah, and Vice Chair of the Alliance Breast Committee. “These results give us the data to safely change practice.”
Key results of the RT CHARM trial
The trial evaluated 828 patients at 209 academic and community medical centers across the United States and Canada. Half of the patients received standard radiation (25 treatments over five to six weeks), while the other half received the shorter radiation schedule (16 treatments over three to four weeks).
“RT CHARM provides the clearest picture to date on how shorter radiation therapy schedules interact with modern breast reconstruction techniques,” added Dr. Poppe. “It gives radiation oncologists, breast surgeons, and plastic surgeons the reliable information they need to help patients make the most informed choices for their care.”
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References: RT CHARM : Phase III randomized trial of hypofractionated postmastectomy radiation with breast reconstruction, Alliance A221505, NCT03414970
Matthew M. Poppe et al. Randomized trial of hypofractionated postmastectomy radiation therapy in women with breast reconstruction (RT CHARM, Alliance A221505). J Clin Oncol , JCO-26-00474. DOI: 10.1200/JCO-26-00474
The Alliance for Clinical Trials in Oncology is a national leader in advancing cancer research, uniting more than 26,000 cancer specialists at 112 main institutions and 1,400 affiliates across the U.S. and Canada. As part of the National Clinical Trials Network and a leading research base for the NCI Community Oncology Research Program, the Alliance conducts pioneering, practice-changing clinical trials that improve outcomes and reshape standards of care. Our work has led to multiple FDA approvals, influenced national guidelines, and produced hundreds of high-impact publications. More than 40,000 participants have taken part in Alliance studies, and our growing biospecimen repository now includes more than 1.5 million samples, collected over the past 30 years. Learn more at AllianceforClinicalTrialsinOncology.org .
Journal of Clinical Oncology
Randomized controlled/clinical trial
People
Randomized Trial of Hypofractionated Postmastectomy Radiation Therapy in Women With Breast Reconstruction (RT CHARM, Alliance A221505)
12-Oct-2026
Supported in whole or in part by the National Cancer Institute of the National Institutes of Health (NIH) under Award Numbers U10 CA180821 and UG1 CA189823 (to the Alliance for Clinical Trials in Oncology), UG1CA233290, UG1CA233178, UG1CA233337, UG1CA233373, UG1CA239767, U10CA180863, CCS 707213 (CCTG), and U10CA180868 (NRG Oncology). https://ascopubs.org/doi/abs/10.1200/JCO-26-00474#sec-8