Abstract
BackgroundTo assess the oncologic outcomes of hypofractionated whole breast irradiation (Hypo-WBI).MethodsEligible patients had undergone breast conservative surgery for early breast cancer (pTis-2) and none/limited nodal involvement. Hypo-WBI consisted of 34 Gy in 10 daily fractions over 2 weeks to the whole breast three-dimensional conformal radiotherapy (3DCRT), followed by a single fraction of 8 Gy to the tumor bed after 1 week (electrons). Primary endpoint is freedom from ipsilateral breast tumor recurrence (IBTR). Minimum follow up for living & event-free patients is 3 yrs.; median follow up time of the whole analyzed patient population is 5.4 yrs. (range: 1.8–11.4 yrs).ResultsTwo hundred fifty-one patients were accrued from 2004 to 2013. All patients underwent local excision of the primary tumor to negative margins. Four patients failed in the ipsilateral breast after a median time of 3.2 years (range: 1.7–5.7 yrs) for a 5-year IBTR-free survival of 98.7% (95%CI: 97.3%–100%). IBTR-free survival was significantly higher for patients with invasive cancer than for patients with intraductal carcinoma (p = 0.036). Within patients with invasive tumors, no clear trends or associations were detected between IBTR and age, grading, molecular subtype, pT or pN stage. At 5 years, the actuarial rates of GR2 fibrosis and GR2+ teleangectasia are 2.4% (95%CI: 0–6.5%) and 7.1% (95%CI: 0.4–13.7%), respectively. Cosmesis was scored as excellent/good by ≈95% of patients and ≈60% of clinicians.ConclusionsHypo-WBI in 3 weeks allows excellent oncologic outcomes for invasive breast cancer after conservative surgery. Patients with intraductal carcinoma should be treated with Hypo-WBI only within a controlled study.Trial registrationIRE-IFO Ethical and Scientific Committee (cod. RS61/04).
Highlights
To assess the oncologic outcomes of hypofractionated whole breast irradiation (Hypo-whole-breast irradiation (WBI))
None of the prospective trials for Hypo-WBI systematically delivered a tumor bed boost; in the START A and B trials it was left to the Institutional policy, so it was delivered in only a fraction of patients and in a nonrandomized fashion
52 (20.7%), 58 (23.1%), 67 (26.7%) and 44 (17.5%) patients were younger than 50 years, had pT2 primary tumors, had poorly differentiated tumors (G3), were nodal positive, respectively
Summary
To assess the oncologic outcomes of hypofractionated whole breast irradiation (Hypo-WBI). In attempt to improve efficiency, cost of care delivery as well as patient logistics, alternate techniques and dose scheduling have been investigated. Randomized clinical trials in Canada and the UK have demonstrated that shorter treatment regimens (3 to 4 weeks) may be as safe and effective as conventional schedules [5,6,7]. Pinnarò et al Journal of Experimental & Clinical Cancer Research (2017) 36:191 there has not been significant adoption of hypofractionated WBI (Hypo-WBI) in the United States [8]. Other concerns potentially limiting the use of Hypo-WBI are the use of a boost and its timing relative to WBI [4]. The use of a sequential boost of 1–2 weeks after WBI extends the overall treatment time reducing the potential timesaving benefit from hypofractionation
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