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Comparison of Conventional and Hypofractionated Radiotherapy in Breast Cancer Patients in Terms of 5-Year Survival, Locoregional Recurrence, Late Skin Complications and Cosmetic Results

  • Hashemi, Farnaz Amouzegar (Radiation Oncology Research Center, Tehran University of Medical Sciences) ;
  • Barzegartahamtan, Mohammadreza (Mofatteh Hospital, Shahid Beheshti University of Medical Sciences) ;
  • Mohammadpour, Reza Ali (Department of Biostatistics, Health Sciences Research Center, Mazandaran University of Medical Sciences) ;
  • Sebzari, Ahmadreza (Department of Radiation Oncology, Valiasr Hospiatl, Birjand University of Medical Sciences) ;
  • Kalaghchi, Bita (Radiation Oncology Research Center, Tehran University of Medical Sciences) ;
  • Haddad, Peiman (Radiation Oncology Research Center, Tehran University of Medical Sciences)
  • Published : 2016.11.01

Abstract

Bckground: Adjuvant radiation therapy is commonly administered following breast-conserving surgery for breast cancer patients. Hypofractionated radiotherapy can significantly reduce the waiting time for radiotherapy, working load on machines, patient visits to radiotherapy departments and medical costs. Material/Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0) who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy in two arms (hypofractionated radiotherapy arm with 30 patients, dose 42.5 Gy in 16 fractions; and conventional radiotherapy arm with 22 patients, dose 50 Gy in 25 fractions). W compared these two groups in terms of overall survival, locoregional control, late skin complications and cosmetic results. Results: At a median follow-up of 52.4 months (range: 0-64 months), the follow-up rate was 82.6%. Overall, after 60 months, there was no detectable significant differences between groups regarding cosmetic results (p = 0.857), locoregional control or survival. Conclusions: The results confirm that hypofractionated radiotherapy with a subsequent boost is as effective as conventional radiotherapy, is well-tolerated and can be used as an alternative treatment method following breast conservation surgery.

Keywords

Breast cancer;hypofractionated radiotherapy;late skin toxicity;survival

References

  1. Alford SL, Prassas GN, Vogelesang CR, Leggett HJ, Hamilton CS (2013). Adjuvant breast radiotherapy using a simultaneous integrated boost: clinical and dosimetric perspectives. J Med Imaging Radiat Oncol, 57, 222-9. https://doi.org/10.1111/j.1754-9485.2012.02473.x
  2. Bartelink H, Horiot JC, Poortmans PM, et al (2007). Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol, 25, 3259-65. https://doi.org/10.1200/JCO.2007.11.4991
  3. Bride MB, Neal L, Dilaveri CA, Sandhu NP, et al (2013). Factors associated with surgical decision making in women with early-stage breast cancer: a literature review. J Womens Health, 22, 236-42. https://doi.org/10.1089/jwh.2012.3969
  4. Chadha M, Woode R, Sillanpaa J, et al (2013). Early-stage breast cancer treated with 3-week accelerated whole-breast radiation therapy and concomitant boost. Int J Radiat Oncol Biol Phys, 86, 40-4. https://doi.org/10.1016/j.ijrobp.2012.11.010
  5. Early Breast Cancer Trialists' Collaborative Group (2011). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. The Lancet, 378, 1707-16. https://doi.org/10.1016/S0140-6736(11)61629-2
  6. Haviland JS, Owen JR, Dewar JA, et al (2013). The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol, 14, 1086-94. https://doi.org/10.1016/S1470-2045(13)70386-3
  7. Herbert C, Nichol A, Olivotto I, et al (2012). The impact of hypofractionated whole breast radiotherapy on local relapse in patients with grade 3 early breast cancer: a populationbased cohort study. Int J Radiat Oncol Biol Phys, 82, 2086-92. https://doi.org/10.1016/j.ijrobp.2011.01.055
  8. Hoopes DJ, Kaziska D, Chapin P, et al (2012). Patient preferences and physician practice patterns regarding breast radiotherapy. Int J Radiat Oncol Biol Phys, 82, 674-81. https://doi.org/10.1016/j.ijrobp.2010.11.077
  9. Hutchinson L (2010). Breast cancer: challenges, controversies, breakthroughs. Nat Rev Clin Oncol, 7, 669-70. https://doi.org/10.1038/nrclinonc.2010.192
  10. Jones B, Dale RG, Finst P, Khaksar SJ.(2000). Biological equivalent dose assessment of the consequences of hypofractionated radiotherapy. Int J Radiat Oncol Biol Phys, 47, 1379-84. https://doi.org/10.1016/S0360-3016(00)00571-X
  11. Keating NL, Landrum MB, Brooks JM, et al (2011). Outcomes following local therapy for early-stage breast cancer in non-trial populations. Breast Cancer Res Treat, 125, 803-13. https://doi.org/10.1007/s10549-010-0865-4
  12. Khan A, Haffty BG (2010). Hypofractionation in adjuvant breast radiotherapy. Breast J, 19, 168-71. https://doi.org/10.1016/j.breast.2010.03.004
  13. Kim K, Chie EK, Han W, et al (2011). Concurrent versus sequential administration of CMF chemotherapy and radiotherapy after breast-conserving surgery in early breast cancer. Tumori, 97, 280. https://doi.org/10.1177/030089161109700304
  14. Lievens Y (2010). Hypofractionated breast radiotherapy: financial and economic consequences. Breast J, 19, 192-7. https://doi.org/10.1016/j.breast.2010.03.003
  15. MacLeod N, McIntyre A, Canney PA (2010). What are the minimal standards of radiotherapy planning and dosimetry for "hypofractionated" radiotherapy in breast cancer? Breast J, 19, 172-5. https://doi.org/10.1016/j.breast.2010.03.007
  16. Marcu LG (2010). Altered fractionation in radiotherapy: from radiobiological rationale to therapeutic gain. Cancer Treat Rev, 36, 606-14. https://doi.org/10.1016/j.ctrv.2010.04.004
  17. Owen JR, Ashton A, Bliss JM, et al(2006). Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol, 7, 467-71. https://doi.org/10.1016/S1470-2045(06)70699-4
  18. Qi XS, White J, Li XA (2011). Is ${\alpha}/{\beta}$ for breast cancer really low? Radiother Oncol, 100, 282-8. https://doi.org/10.1016/j.radonc.2011.01.010
  19. Romestaing P, Lehingue Y, Carrie C, et al (1997). Role of a 10-Gy boost in the treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol, 15, 963-8. https://doi.org/10.1200/JCO.1997.15.3.963
  20. Smith BD, Bentzen SM, Correa CR, et al (2011). Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Int J Radiat Oncol Biol Phys, 81, 59-68. https://doi.org/10.1016/j.ijrobp.2010.04.042
  21. Suh WW, Pierce LJ, Vicini FA, Hayman JA (2005). A cost comparison analysis of partial versus whole-breast irradiation after breast-conserving surgery for early-stage breast cancer. Int J Radiat Oncol Biol Phys, 62, 790-6. https://doi.org/10.1016/j.ijrobp.2004.10.039
  22. Tortorelli G, Di Murro L, Barbarino R, et al (2013). Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities. BMC Cancer, 13, 1. https://doi.org/10.1186/1471-2407-13-1
  23. Whelan TJ, Pignol JP, Levine MN, et al (2010). Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med, 362, 513-20. https://doi.org/10.1056/NEJMoa0906260
  24. Yarnold J, Ashton A, Bliss J, et al (2005). Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol, 75, 9-17. https://doi.org/10.1016/j.radonc.2005.01.005
  25. Yarnold J, Haviland J (2010). Pushing the limits of hypofractionation for adjuvant whole breast radiotherapy. Breast J, 19, 176-9. https://doi.org/10.1016/j.breast.2010.03.001