Hypofractionated Radiotherapy Reduces Acute Skin Toxicity in Small and Large Breasted Patients Receiving Whole-Breast Irradiation

Abstract PurposePostoperative radiotherapy can reduce the recurrence of breast cancer. Postoperative radiotherapy is divided into whole breast irradiation (WBI) and partial breast irradiation (PBI) for early breast cancers. Due to the characters of saving time, money, and easy to deliver, external beams PBI (EB PBI) is brought into focus. However, the researches on outcomes, safety, and efficacy between EB PBI and WBI are still insufficient. We concluded a meta-analysis for LRR, regional node recurrence, contralateral breast cancer, distant recurrence, mortality, less acute skin toxicity (˃ 1 grade), late skin toxicity and the cosmetic score of external beam partial breast irradiation (EB PBI) and whole breast irradiation(WBI) to develop a radiotherapy plan for early low recurrence risk breast cancer patients. MethodWe searched Pubmed、Embase、Cochrane Library、Clinicaltrals. Study eligibility criteria are as below: (1) RCTs for EB PBI vs WBI; (2) Histologically confirmed breast cancer; (3) AJCC staged Tis-2N0-1M0; (4) ≥ 40 years old; (5) Tumor size ≤ 3 cm;(6) microscopically clear margins ≤ 5 cm; (7) Mean follow-up time༞5 years. All data is used by Cochrane’s Review Manager 5.3 (RevMan) to process.ResultsThere were 4 RCT studies included in our study with 1999 patients in EB PBI group and 1999 patients in EB PBI. There was no statistic difference between PBI and WBI groups in local recurrence rates (RR = 1.15; 95% CI, 0.76 to 1.74; p = 0.52; I2 = 0%), regional node recurrence(RR = 1.00; 95% CI, 0.49 to 2.04, p = 0.99, I2 = 0%), contralateral breast cancer (RR = 0.79; 95% CI, 0.54 to 1.16; p = 0.23; I2 = 0%), distant recurrence(RR = 1.00; 95% CI, 0.63 to 1.59; p = 1.00; I2 = 0%), non-breast second cancer (RR = 1.03; 95% CI, 0.50 to 2.16; p = 0.93; I2 = 83%), mortality(RR = 0.96; 95% CI, 0.60 to 1.55; p = 0.88, I2 = 54%). EB PBI had worse cosmetic score (RR = 1.56; 95% CI, 1.04 to 2.34; p = 0.003, I2 = 84%), less acute skin toxicity (˃ 1 grade) (RR = 0.17; 95% CI, 0.07 to 0.42; p༜ 0.0001, I2 = 87%) and late skin toxicity(RR = 0.65; 95% CI, 0.48 to 0.88; p = 0.005; I2 = 27%) than WBI.ConclusionEB PBI has similar LRR, regional node recurrence, contralateral breast cancer, distant recurrence, non-breast second cancer and mortality with WBI. But EB PBI has worse cosmetic score, less acute skin toxicity (˃ 1 grade) and late skin toxicity than WBI.

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Hypofractionated radiotherapy in ten fractions for postmastectomy patients: a phase II study compared with another hypofractionation schedule with sixteen fractions

BMC Cancer ◽

10.1186/s12885-021-09032-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Huayong Jiang ◽

Lingling Meng ◽

Huijuan Zhang ◽

Xiangkun Dai ◽

Qian Zhang ◽

...

Keyword(s):

Phase Ii ◽

Phase Ii Study ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Disease Free Survival ◽

Skin Toxicity ◽

Trial Registration ◽

Hypofractionated Radiotherapy ◽

Free Survival ◽

Acute Skin Toxicity

Abstract Background The purpose of this phase II study was to evaluate the feasibility of hypofractionated radiotherapy (HFRT) with a dose of 36.5 Gy in 10 fractions in postmastectomy patients. Methods From March 2014 to December 2015, 85 patients with locally advanced breast cancer were eligible to participate in this study with a schedule of 36.5 Gy in 10 fractions. Intensity-modulated radiation therapy (IMRT) was delivered to the chest wall with or without the supraclavicular region. The primary endpoint was radiation-related toxicities. The secondary endpoints were locoregional failure-free survival (LRFFS), disease-free survival (DFS) and overall survival (OS). And the outcomes were compared with our retrospective study of 72 patients with 42.5 Gy in 16 fractions. Results The median follow-up was 69.0 (range 66.5-71.5) months in the 36.5 Gy group and 93.0 (range 91.9-94.1) months in the 42.5 Gy group, respectively. Radiation-related toxicities were mainly grade 1, although a few patients had grade 2 plexopathy (1.2%) and acute skin toxicity (1.2%) in the 36.5 Gy group, and grade 2 acute skin toxicity (5.6%) and lymphedema (4.2%) in the 42.5 Gy group. There were no significant differences between the groups in acute and late toxicities. For all the patients, the 5-year LRFFS, DFS and OS were 97.7 and 100.0%, 93.1 and 90.3%, 98.8 and 97.2%, respectively, without significant differences between the groups. Conclusion Postmastectomy HFRT with a schedule of 36.5 Gy in 10 fractions was feasible, with mild toxicities and excellent 5-year clinical outcome. Trial registration Trial registration number: ChiCTR-ONRC-14004391. Date of registration: 9/3/2014.

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Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities

BMC Cancer ◽

10.1186/1471-2407-13-230 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 31

Author(s):

Grazia Tortorelli ◽

Luana Di Murro ◽

Rosaria Barbarino ◽

Sara Cicchetti ◽

Daniela di Cristino ◽

...

Keyword(s):

Breast Cancer ◽

Retrospective Analysis ◽

Skin Toxicity ◽

Postoperative Treatment ◽

Hypofractionated Radiotherapy ◽

Acute Skin Toxicity

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Radiochromic film in vivo dosimetry predicts early the risk of acute skin toxicity for brachytherapy partial breast irradiation

Physics in Medicine and Biology ◽

10.1088/1361-6560/ab7c2f ◽

2020 ◽

Vol 65 (8) ◽

pp. 085001

Author(s):

Gerson M Struik ◽

Jeremy Godart ◽

Taco M Klem ◽

Thalat T Monajemi ◽

James Robar ◽

...

Keyword(s):

Skin Toxicity ◽

Radiochromic Film ◽

In Vivo Dosimetry ◽

Partial Breast Irradiation ◽

Breast Irradiation ◽

Acute Skin Toxicity

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Accelerated Hypofractionated Radiotherapy With Simultaneous Integrated Boost With Volumetric Modulated Arc Technique in Patients With Breast Cancer: a Phase 2 Study.

10.21203/rs.3.rs-542950/v1 ◽

2021 ◽

Author(s):

Budhi Singh Yadav ◽

Shipra Gupta ◽

Divya Dahiya ◽

Ankita Gupta ◽

Arun Oinam

Keyword(s):

Breast Cancer ◽

Organs At Risk ◽

Disease Free Survival ◽

Skin Toxicity ◽

Simultaneous Integrated Boost ◽

Hypofractionated Radiotherapy ◽

Acute Skin Toxicity ◽

Integrated Boost ◽

Left And Right ◽

Accelerated Hypofractionated Radiotherapy

Abstract PurposeTo assess feasibility of accelerated hypofractionated radiotherapy with simultaneous integrated boost (SIB) with volumetric modulated arc technique (VMAT) in patients with breast cancer.Methods Total 27 patients after breast conserving surgery (BCS) were included in this study. Patients were planned on 4-dimensional computerized tomogram (4D-CT) and contouring was done using RTOG guidelines. Dose delivered was 34 Gy/10#/2wk to the breast and 40 Gy/10#/2wk to the tumor bed as SIB with VMAT technique. The primary endpoint was grade 2 acute skin toxicity. Doses to the organs at risk were calculated. Toxicities and cosmesis were assessed using RTOG LENT-SOMA and HARVARD/NSABP/RTOG grading scales, respectively. Disease-free survival (DFS) and overall survival (OS) was calculated with Kaplan Meier curves.ResultsMean age of the patients was 42 years. Left and right breast cancer was seen in 17 (63%) and 10 (37%) patients, respectively. Ipsilateral lung mean V16 and contralateral lung V5 was 16.01% and 3.73%, respectively. Mean heart dose from the left and right breast was 7.25Gy and 4.37Gy, respectively. Mean dose to the contralateral breast, oesophagus and spinal cord was 2.64Gy, 3.69Gy and 3.15Gy, respectively. Thyroid V25 mean was 19.69%.Grade 1 and 2 acute skin toxicity was observed in 9 (33%) and 5 (18.5%) patients, respectively. Grade 2 hyperpigmentation, edema and induration were observed in 1 (3.7%), 2 (7.4%) and 4(14.8%) patients, respectively. Mild breast pain and arm/shoulder discomfort were reported by 1 (3.4%) patient each. Median follow-up was 48 months (range 12-58 months). At 4 years breast induration, edema and fibrosis each were observed in 1(3.7%) patient. Cosmesis was excellent and good in 21 (78%) and 6 (22%) patients, respectively. Local recurrence and distant metastases occurred 1(3.7%) and 2(7.4%) patients, respectively. DFS and OS at 3-years was 88% and 92%, respectively.ConclusionWith this RT schedule acute and late toxicity rates were acceptable with no adverse cosmesis. Local control, DFS and OS were good.

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Hypofractionated Radiotherapy for Post-Operative Breast Cancer Patients at Delta Hospital - an Evaluation of Clinical Experience

Delta Medical College Journal ◽

10.3329/dmcj.v3i1.22232 ◽

2015 ◽

Vol 3 (1) ◽

pp. 4-8 ◽

Cited By ~ 1

Author(s):

Parvin Akhter Banu ◽

Naheed Rukhsana ◽

MA Jabber ◽

Motiur Rahman ◽

Sadiq R Malik

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Cancer Patients ◽

Ductal Carcinoma ◽

Therapy Group ◽

Breast Conservation ◽

Skin Toxicity ◽

Hypofractionated Radiotherapy ◽

Breast Cancer Patients ◽

Acute Skin Toxicity

Background: As hypofractionated radiotherapy for post-operative breast cancer patients safe, effective and more convenient, it might be beneficial for patients of developing countries like ours. Objective: This study was done to evaluate the safety and efficacy of hypofractionated whole breast radiation therapy in patients who underwent breast conserving surgery and hypofractionated radiation therapy in patients who underwent mastectomy and axillary clearance. Materials and method: This cross sectional study was conducted in Delta Hospital Ltd, Dhaka, Bangladesh, including 50 postoperative patients, (12 patients in Breast Conservation Therapy group and 38 in Post Mastectomy Radiation Therapy group), with invasive ductal carcinoma of breast treated with this hypofractionated radiotherapy protocol during the last 1.5 year. The patients were treated with 3DCRT, LINAC, 6 MV photon and appropriate electron energy. Results: Minimal post treatment acute morbidity was observed. Forty seven patients (94%) had grade-I acute skin toxicity and only 3 patients (6%) developed grade-II acute skin toxicity. Conclusion: Hypofractionated radiotherapy is as safe and effective as conventional fractionated radiotherapy and superior in terms of convenience. DOI: http://dx.doi.org/10.3329/dmcj.v3i1.22232 Delta Med Col J. Jan 2015; 3(1): 04-08

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