Abstract
BackgroundA variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The aim of the present study is to assess acute and late toxicity of using daily fractionation of 2.25 Gy to a total dose of 45 Gy to the whole breast in a mono-institutional series.MethodsEighty-five women with early breast cancer were assigned to receive 45 Gy followed by a boost to the tumour bed. Early and late toxicity were scored according to the Radiation Therapy Oncology Group criteria. For comparison, a group of 70 patients with similar characteristics and treated with conventional fractionation of 2 Gy to a total dose of 50 Gy in 25 fractions followed by a boost, was retrospectively selected.ResultsOverall median treatment duration was 29 days for hypofractionated radiotherapy and 37 days for conventional radiotherapy. Early reactions were observed in 72/85 (85%) patients treated with hypofractionation and in 67/70 (96%) patients treated with conventional fractionation (p = 0.01). Late toxicity was observed in 8 patients (10%) in the hypofractionation group and in 10 patients (15%) in the conventional fractionation group, respectively (p = 0.4).ConclusionsThe hypofractionated schedule delivering 45 Gy in 20 fractions shortened the overall treatment time by 1 week with a reduction of skin acute toxicity and no increase of late effects compared to the conventional fractionation. Our results support the implementation of hypofractionated schedules in clinical practice.
Highlights
A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time
The aim of the present study carried out in a monoinstitutional clinical setting is to assess acute and late toxicity of hypofractionated radiotherapy after conservative surgery using a regimen of 2.25 Gy/fraction to a total dose of 45 Gy to the whole breast followed by a boost comparing the results with those of a similar group of patients treated with conventional fractionation schedule
Patients From January 2006 to January 2008, 85 patients with invasive carcinoma of the breast treated with conservative surgery and biopsy of sentinel lymph node or axillary lymph node dissection were prospectively treated with whole breast irradiation of 45 Gy in 20 fractions, 2.25 Gy/fraction, followed by 9 Gy in 3 fractions to the tumour bed as a boost dose
Summary
A variety of hypofractionated radiotherapy schedules has been proposed after breast conserving surgery in the attempt to shorten the overall treatment time. The START Trial A tested two dose levels of a 13-fractions regimen delivered over 5 weeks and the START Trial B compared 40 Gy in 15 fractions of 2.67 Gy in 3 weeks with a control group of 50 Gy in fractions of 2.0 Gy over 5 weeks These studies seem to offer rates of late adverse effects and local-regional tumour relapse at least as favourable as the standard schedule. The aim of the present study carried out in a monoinstitutional clinical setting is to assess acute and late toxicity of hypofractionated radiotherapy after conservative surgery using a regimen of 2.25 Gy/fraction to a total dose of 45 Gy to the whole breast followed by a boost comparing the results with those of a similar group of patients treated with conventional fractionation schedule
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