Abstract
Purpose Radiation therapy is a key treatment of breast cancer. Elderly patients with associated diseases that modify their performance status do not tolerate long periods of daily irradiation. The objective of this study is to analyze the results of weekly hypofractionated treatment in these patients. Material and Methods Between 1992 and 2016, we included 486 elderly patients presenting concomitant pathology or sociofamilial problems in which it was not feasible to propose conventional treatment. They were treated with conservative surgery or mastectomy and then adjuvant hypofractionated irradiation, administering 5 Gy or 6.25 Gy in 6 fractions, once a week (total dose 30–37.5 Gy) over 6 weeks. Results Breast cancer overall survival according to the Kaplan-Meier method at 5 years was 74.2% ± 2.3%; breast cancer disease-free survival was 90% ± 1.6%; local relapse-free survival was 96.5% ± 1% showing that patients die more from other causes and not from their neoplasia. Acute dermatitis was mild (75.6% of the patients grades I–III) and 30.6% had moderate chronic fibrosis. Conclusions The once-weekly hypofractionated radiotherapy is a feasible and convenient option for elderly patients with breast cancer. It is a safe treatment modality with similar survival and local control results compared to standard fractionation, while the side effects are acceptable.
Highlights
Breast cancer is the most common tumor in women [1]
The most common regimen for the complementary treatment of breast cancer after conservative [3] or radical surgery has been the standard fractionation, consisting of 45–50 Gy in 25 fractions of 1.8 or 2 Gy/day, 5 days a week, for 33 days [4, 5]. These studies show that the incidence of local recurrence is significantly lower in the group of patients treated with radiotherapy, about an 8%–10% with respect to the nonirradiated ones in which the local recurrence reached 25%–35%, independently of other associated factors
Patients are frequently associated with concomitant diseases, cognitive impairment, sociofamilial problems, or functional limitation [9]
Summary
Breast cancer is the most common tumor in women [1]. The incidence rate continues to increase slowly in both developed and underdeveloped countries. The most common regimen for the complementary treatment of breast cancer after conservative [3] or radical surgery has been the standard fractionation, consisting of 45–50 Gy in 25 fractions of 1.8 or 2 Gy/day, 5 days a week, for 33 days [4, 5] These studies show that the incidence of local recurrence is significantly lower in the group of patients treated with radiotherapy, about an 8%–10% with respect to the nonirradiated ones in which the local recurrence reached 25%–35%, independently of other associated factors. According to established practice, it is not always feasible for elderly patients to indicate a conventional, daily treatment [10] This may lead to individuals avoiding complementary treatment after conservative surgery, or unnecessary abuse of BioMed Research International radical mastectomy in the initial stages, which results in an undertreatment or overtreatment in a large number of cases. It is advisable to plan a more convenient treatment regimen for the elderly patients while a similar local control result can be achieved
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