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Biologically effective dose and breast cancer conservative treatment: is duration of radiation therapy really important?

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Abstract

To evaluate if biologically effective dose (BED), and in particular the duration of radiation treatment, has an effect on local relapse risk. Between January 2000 and December 2008 a total of 762 patients with T1-2 N0/+ breast cancer was treated with breast-conserving surgery and radiotherapy, with and without hormone therapy and chemotherapy. Adjuvant radiation therapy was administered to a total dose of 60–66 Gy in 30–33 fractions. The computed BEDs were divided in four groups: <43.1, 43.1–44.9, 45.0–46.1, and >46.1 Gy (A–D, respectively). Kaplan–Meier method was used to calculate local relapse rates. Cox regression method was used to identify prognostic factors of local relapse. Evaluated variables were age, tumor histology, tumor size, surgical margin status, axillary nodal status, tumor grading, adjuvant therapies, adjuvant chemotherapy alone, adjuvant hormone therapy alone, adjuvant anthracyclines, and BEDs values. 8-year local relapse rates were 18.0% for group A, 8.5% for group B, 4.6% for group C, and 2.7% for group D (P = 0.008). Multivariate Cox regression analysis showed that BEDs values were associated with higher local relapse risk (P = 0.001). In our study, a prolongation of radiotherapy treatment, intended as a lower BED value, after breast-conserving surgery is associated with an increased risk of local relapse. Considering the wide range of results published in other studies, hypofractionation for breast cancer should be considered, at the moment, feasible in selected patients.

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Acknowledgments

The authors thank Dr. Loreta Sanpaolo for helping us with this manuscript and editor and reviewers for their helpful comments.

Conflict of interest

All Authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) this study.

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Authors and Affiliations

  1. Radiation Oncology Department, CROB, Via Padre Pio 1, 85028, Rionero in Vulture, Potenza, Italy

    Pietro Sanpaolo, Viviana Barbieri & Vincenzo Fusco

  2. Radiation Oncology Department, G. D’Annunzio University, Via dei Vestini, 66013, Chieti, Italy

    Domenico Genovesi & Giampiero Ausili Cèfaro

Authors
  1. Pietro Sanpaolo
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  2. Viviana Barbieri
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  3. Domenico Genovesi
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  4. Vincenzo Fusco
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  5. Giampiero Ausili Cèfaro
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Corresponding author

Correspondence to Pietro Sanpaolo.

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Sanpaolo, P., Barbieri, V., Genovesi, D. et al. Biologically effective dose and breast cancer conservative treatment: is duration of radiation therapy really important?. Breast Cancer Res Treat 134, 81–87 (2012). https://doi.org/10.1007/s10549-011-1932-1

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  • DOI: https://doi.org/10.1007/s10549-011-1932-1

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