5 years local recurrencce rates following post-operative 2D radiotherapy treatment planning patients – An institutional experience

Abstract

Introduction: In India, almost 150,000 women are diagnosed with breast cancer every year and almost half of patients expected to die of the disease. In India most of patients with breast cancer diagnosed with advanced stage of the disease. As breast cancer treatment is multimodality approach Radiation therapy has significant impact on prevention of local recurrence. So, purpose of the study is to assess 5 year rates of local recurrence following post-operative 2D Radiotherapy treatment planning. Methods and Materials: We have selected 198 patients treated for post-operative 2D Radiotherapy treatment planning from September 2009-September 2010. All patients had undergone surgery in form of mastectomy or modified radical mastectomy. None of the patients with breast conservation surgery had been selected. All patients underwent chemotherapy either Induction chemotherapy following surgery or chemotherapy after surgery. All patients had been treated with 2D conventional Radiotherapy treatment plan with tangential fields and supraclavicular and axillary fields according to histopathology report. Patients were first taken on simulator machine and planning was done with breast wedge in position and fully abducted arm of the patient. Radiotherapy treatment dose was – 45Gy/20#, 2.25Gy/#, 5 days/week, total 4 weeks of treatment. Patients were assessed for acute toxicity every week. Patients were followed every monthly for 2 years, 2 monthly for 3rd year, 4 monthly for 4th year up to 5 year. Patients were assessed for Local recurrence up to 5 years. Results: 152 (77%) patients had undergone upfront Surgery. 46 (23%) patients were diagnosed with LABC, and had undergone chemotherapy first for downstage of the disease. After a median follow up of 34 months (range: 9-67 months), out of total 198 patients, 8.6% patients developed local recurrence. In which 6.5% (10 patients out of 152) in upfront surgery group and 15.2% (7 patients out of 46) in LABC group developed local recurrence. So, total 5% (10 patients) in upfront surgery group and 3.5% (7 patients) in LABC group out of 198 total patients developed local recurrence. Conclusion: Local recurrence after treatment of breast cancer with mastectomy+radiotherapy+/-systemic therapy is associated with a significantly higher risk of distant metastasis and death. So, in this retrospective study we have shown comparable results after 2D Conventional Radiotherapy Treatment Planning for prevention of local recurrence. Approach is safe, easy, and feasible, less time consuming and in Indian scenario where patients come in advanced stage of the disease and most of the time death is due to disease itself it is quite suitable approach at our centre. Also, we use hypofractionation regimen of 45Gy/20#, which is also feasible to reduce total treatment time and it has also shown equivalent results.