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Given the increasing incidence of most malignancies with age, it is not surprising that the majority of cancer patients undergoing radiotherapy are older. Treatment of cancer in the elderly requires special consideration of many challenging issues, such as the impact of comorbid conditions on treatment selection, and social factors, including transportation. Radiation oncology is in the midst of a paradigm shift with the potential to address these issues. This new trend, known as hypofractionation, shortens the duration of treatment by delivering fewer, larger fractions. With its higher biological effectiveness for a given dose, hypofractionated radiotherapy also has the potential to be a more effective alternative to surgery in patients unable to undergo an operation. In this review, we discuss how hypofractionation is changing the treatment of the three most common cancers in the elderly – namely lung, prostate and breast cancer – and how elderly patients stand to benefit from this change.