Study of two different dose fractionation schedules of post mastectomy chest wall irradiation in carcinoma breast patients

Abstract

Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women. Aim: To compare two different dose fractionation schedules in terms of overall treatment, locoregional control, acute and late toxicities and patient compliance. Materials and methods: Patients of postmastectomy non metastatic breast cancer were randomized in two arms: Arm A (45) Arm B (46) according to dose fractionation schedule of external radiation given to chest wall and draining lymphatics. Arm A was given 50 Gy in 25 fractions and Arm B was given 40Gy in 17 fractions. After completion of radiation patients were kept on follow up. Results: Median follow up was 20 months. In arm A & B the median overall treatment time was 40 and 27 days with respective ranges of 36-47 days and 22-33 days .The patients in both the arms tolerated radiation well, skin reactions were most common followed by nausea and vomiting .Grade II and III acute reactions were comparable in both arms. There was non-significant increase in both late skin and subcutaneous skin toxicities in arm B. Result of treatment of both arms are, chest wall failure 5% v/s 9% (p>.05), nodal failure 8% v/s 7%(p>.05) and distant metastasis 25% v/s 28% (p>.05). Conclusion: Both the studied dose fractionation schedules are equally efficacious in terms of locoregional control, acute and late toxicities. The shorter schedules in Arm B gives an added advantage of decreased overall treatment time giving better compliance and reduces work load of overburdened department.