Abstract
PurposeThe objective of this study is to evaluate toxicity and cosmetic outcome in breast cancer patients treated with adjuvant hypo fractionated radiotherapy to the whole breast, and to identify the risk factors for toxicity.Methods and materialsTwo hundred twelve women with early breast cancer underwent conserving surgery were enrolled in the study. The patients received 40.05 Gy in 15 daily fractions, 2.67 Gy per fraction. The boost to the tumor bed was administered with a total dose of 9 Gy in 3 consecutive fractions in 55 women. Physician-rated acute and late toxicity and cosmetic outcome (both subjective and objective) were prospectively assessed during and after radiotherapy.ResultsIn our population study the mean age was 63 with the 17% (36 pts) of the women younger than 50 years.The median follow-up was 34 months. By the end of RT, 35 patients out of 212 (16%) no acute toxicity, according to the RTOG criteria, while 145 (68%) and 31 patients (15%) developed grade 1 and grade 2 acute skin toxicity, respectively.Late skin toxicity evaluation was available for all 212 patients with a minimum follow up of 8 months. The distribution of toxicity was: 39 pts (18%) with grade 1 and 2 pts (1%) with grade 2. No worse late skin toxicity was observed.Late subcutaneous grade 0-1 toxicity was recorded in 208 patients (98%) and grade 2 toxicity in 3 patients (2%), while grade 3 was observed in 1 patient only. At last follow up, a subjective and objective good or excellent cosmetic outcome was reported in 93% and 92% of the women, respectively. At univariate and multivariate analysis, the late skin toxicity was correlated with the additional boost delivery (p=0.007 and p=0.023). Regarding the late subcutaneous tissue, a correlation with diabetes was found (p=0.0283).ConclusionThese results confirm the feasibility and safety of the hypofractionated radiotherapy in patients with early breast cancer. In our population the boost administration was resulted to be a significant adverse prognostic factor for acute and late toxicity. Long-term follow up is need to confirm this finding.
Highlights
The radiation therapy represents the standard adjuvant treatment for the early-stage breast cancer after breast conserving surgery (BCS), in order to maximize local control and overall survival [1]
Late subcutaneous grade 0-1 toxicity was recorded in 208 patients (98%) and grade 2 toxicity in 3 patients (2%), while grade 3 was observed in 1 patient only
A subjective and objective good or excellent cosmetic outcome was reported in 93% and 92% of the women, respectively
Summary
The radiation therapy represents the standard adjuvant treatment for the early-stage breast cancer after breast conserving surgery (BCS), in order to maximize local control and overall survival [1]. There has been concern that the wholebreast radiotherapy using daily dose > 2 Gy/fraction might increase late toxicity and impair cosmesis in BCS patients [7], over the last years, there has been renewed interest in hypofractionated whole breast irradiation (HF-WBI), defined as a larger daily dose delivered often over a shorter time period. HF-WBI is associated with reduction in the length of treatment by 2-3 weeks compared to conventional schedules that require 6-7 weeks. This approach have important practical advantages and biological implications. Because of the greater risk of worse fibrosis and skin toxicity, several studies hypo fractionation excluded the large-breasted women [8]; some other trials included these patients but without providing clear information about the impact of breast volume on toxicity and cosmesis [10,13]
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