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Hypofractionation in post-mastectomy breast cancer patients: seven-year follow-up

Medical Oncology volume 29, pages 2570–2576 (2012)Cite this article

Abstract

To compare three fractionation schedules in post-mastectomy patients treated with radiotherapy as regard acute and early late effects as well as local recurrence rates. One hundred and seven breast cancer patients treated with modified radical mastectomy and adjuvant radiotherapy ± adjuvant systemic treatments between November 2001 and July 2004 were enrolled in this study. Patients were categorized into three groups. Group A (41 patients) received conventional fractionation 50 Gy over 25 fractions. Group B (36 patients) received other fractionation regimen 45 Gy over 17 fractions. Group C (30 patients) received 40 Gy over 15 fractions. The median follow-up period was 23 months. There has been no statistical significant difference in local control (P = 0.88), pain (P = 0.98), telangectasis (P = 0.23), fibrosis (P = 0.13), arm oedema (P = 0.96) or pigmentation (P = 0.80) between the three groups. GII-III Erythema was significantly higher in the two hypofractionation arms compared to the control arm (P = 0.001). Although acute skin reactions were higher in the hypofractionated arms, there was no significant difference in the local recurrence rates or late radiation effects. A national randomized multicentre study is recommended to explore this further.

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References

  1. Bartelink H, Garavaglia G. Quality assurance in conservative treatment of early breast cancer. Report on a consensus meeting of the EORTC radiotherapy and breast cancer cooperative groups and the EUSOMA. Radiother Oncol. 1991;22:323–6.

    Article  PubMed  CAS  Google Scholar 

  2. Morrow M, Strom E, Basset L, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin. 2002;52:277–300.

    Article  PubMed  Google Scholar 

  3. Voordeckers M, Vande Steene J, Vinh-Hung V, et al. Adjuvant radiotherapy after mastectomy for pT1-pT2 node negative(pN0) breast cancer: is it worth the effort? Radiother Oncol. 2003;68:227–31.

    Article  PubMed  Google Scholar 

  4. Johansson S, Sevensson H, Denekamp J. Time scale of evolution of late radiation injury after postoperative radiotherapy of breast cancer patients. Int J Radiat Oncol Bio Phys. 2000;48:745–50.

    Article  CAS  Google Scholar 

  5. Whelan T, Marcellus D, Clarck R, et al. Adjuvant radiotherapy for early breast cancer: pattern of practice in Ontario. CAMAJ. 1993;149:1273–7.

    CAS  Google Scholar 

  6. Yarnold J, Price P, Steel G. Non surgical management of early breast cancer in the United Kingdom: radiotherapy fractionation practices. Clinical Audit sub-committee of the Faculty of Clinical Oncology, Royal College of Radiologist, and the Joint Council for Clinical Oncology. Clin Oncol. 1995;7:223–6.

    Article  CAS  Google Scholar 

  7. Priestman TJ, Bullimore JA, Godden TP, et al. The royal college of radiologist fractionation survey. Clin Oncol. 1989;11:39–46.

    Article  Google Scholar 

  8. Clark RM, McCulloch PB, Levine MN, et al. Randomized clinic trial to assess the effectiveness of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer. J Natl Cancer Inst. 1992;84:683–9.

    Article  PubMed  CAS  Google Scholar 

  9. Clark RM, Whelan T, Levine M, et al. Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. J Natl Cancer Inst. 1996;88:1659–64.

    Article  PubMed  CAS  Google Scholar 

  10. Whelan T, Mackenzie R, Julian J, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94:1143–50.

    Article  PubMed  Google Scholar 

  11. Ortholan C, Hannoun-Levi JM, Ferrero JM, et al. Long-term results of adjuvant hypofractionated radiotherapy for breast cancer in elderly patients. Int J Radiat Oncol Bio Phys. 2005;61:154–62.

    Article  Google Scholar 

  12. Bentzen SM, Agrawal RK, Aird EG, et al. The UK standardisation of breast radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;V371:1098–107.

    Google Scholar 

  13. Shelley W, Brundage M, Hayter C, et al. A shorter fractionation schedule for post lumpectomy breast cancer patients. Int J Radiat Oncol Bio Phys. 2000;47:1219–28.

    Article  CAS  Google Scholar 

  14. Rodger A. Fears over radiotherapy fractionation regimens in breast cancer. Proposed UK trial needs to define techniques as well as numbers of treatments. BMJ. 1998;317(7152):155–6.

    Article  PubMed  CAS  Google Scholar 

  15. Fourquet A, Campana F, Zafrani B, et al. Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25 years follow-up. Int J Radiat Oncol Biol Phys. 1989;17:719–25.

    Article  PubMed  CAS  Google Scholar 

  16. Kurtz JM, Jacquemier J, Amarlic R, et al. Risk factors for breast recurrence in pre menopausal and post menopausal patients with ductal cancer treated with breast conservation therapy. Cancer. 1990;65:1867–78.

    Article  PubMed  CAS  Google Scholar 

  17. Touboul E, Buffat L, Belkacemi Y, et al. Local recurrence and breast metastasis after breast conserving surgery and radiation therapy for early breast cancer. Int J Radiat Oncol Biol Phys. 1999;43:25–138.

    Article  PubMed  CAS  Google Scholar 

  18. Wu JX, Hui ZG, Yu ZH. Post mastectomy radiotherapy with different fractionated dose schemes in early breast cancer (Abstract). Zhonghua zhong Liu Za Zhi. 2003;25:285–8.

    PubMed  Google Scholar 

  19. Goel A, Kaushal V, Hooda HS, et al. Comparison of two-radiation dose schedules in post mastectomy carcinoma of the breast. Indian J Med Sci. 2000;54:278–83.

    PubMed  CAS  Google Scholar 

  20. Whelan T. As presented at American College of Surgeons Oncology Group, Breast Section, Montreal, Canada, June 5, 2003.

  21. Olivotto IA, Weir LM, Kim-Sing C, et al. Late cosmetic results of short fractionation for breast conservation. Radiother Oncol. 1996;41:7–13.

    PubMed  CAS  Google Scholar 

  22. Yoshiya Y, Ida A, Edmee F, et al. Does the dose fractionation schedule influence local control of adjuvant radiotherapy for early stage breast cancer? Int J Radiat Oncol Bio Phys. 1999;44:99–104.

    Article  Google Scholar 

  23. Lopez E, Guerrero R, Nunez M, et al. Early and late skin reactions to radiotherapy for breast cancer and their correlation with radiation induced DNA damage in lymphocytes. Breast Cancer Res. 2005;7:690–8.

    Article  Google Scholar 

  24. Spierer MM, Hong LX, Raouel T, et al. Post mastectomy CT-based electron beam radiotherapy: dosimetry, efficacy and toxicity in 118 patients. Int J Radiat Oncol Bio Phys. 2004;60:1182–9.

    Article  Google Scholar 

  25. Rostom AY, Pradhan DG, White WF. Once weekly irradiation in breast cancer. Int J Radiat Oncol Biol Phys. 1987;13:551–5.

    Article  PubMed  CAS  Google Scholar 

  26. Taher A, El-Baradie M, Essa H, et al. Hypofractionation versus conventional fractionation radiotherapy after conservative treatment of breast cancer: early skin reactions and cosmetic results. J Egypt Nat Cancer Inst. 2004;16:178–87.

    PubMed  Google Scholar 

  27. Shahid A, Athar MA, Asghar S, et al. Post mastectomy adjuvant radiotherapy in breast cancer: a comparison of three hypofractionated protocols. J Pak Med Assoc. 2009;59(5):282–7.

    PubMed  Google Scholar 

  28. Marcenaro M, Sacco S, Pentimalli S, et al. Measures of late effects in conservative treatment of breast cancer with standard or hypofractionated radiotherapy. Tumori. 2004;90:586–91.

    PubMed  Google Scholar 

  29. Romestaing P, Lehingue Y, Carrier C, et al. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon. France J Clin Oncol. 1997;15:963–8.

    CAS  Google Scholar 

  30. Hoeller U, Tribius S, Kuhlmey A, et al. Increasing the rate of late toxicity by changing the score? A comparison of RTOG/EORTC and LENT/SOMA scores. Int J Radiat Oncol Biol Phys. 2003;55:1013–8.

    Article  PubMed  Google Scholar 

  31. Hopwood P, Haviland JS, Georges Sumo G, et al. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol. 2010;11:231–40.

    Article  PubMed  Google Scholar 

  32. Dische S, Warburton MF, Jones D, et al. The recording of morbidity related to radiotherapy. Radiother Oncol. 1989;16:103–8.

    Article  PubMed  CAS  Google Scholar 

  33. Baker MR, Bader D, Hopewell JW. The effects of single doses of X rays on the mechanical properties of pig skin in vivo. Br J Radiol. 1989;62:830–7.

    Article  PubMed  CAS  Google Scholar 

  34. Warszawski A, Rottinger EM, Vogel R, et al. 20 MHz ultrasonic imaging for quantitative assessment and documentation of early and late post radiation skin reactions in breast cancer patients. Radiother Oncol. 1998;47:241–7.

    Article  PubMed  CAS  Google Scholar 

  35. Russell NS, Knaken H, Bruinvis IA, et al. Quantification of patient to patient variation of skin erythema developing as a response to radiotherapy. Radiother Oncol. 1994;30:213–21.

    Article  PubMed  CAS  Google Scholar 

  36. Gorodetsky R, Lotan C, Piggot K, et al. Late effects of dose fractionation on the mechanical properties of breast skin following post-lumpectomy radiotherapy. Int J Radiat Oncol Biol Phys. 1999;45:893–900.

    Article  PubMed  CAS  Google Scholar 

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Conflict of interest

The authors have no financial or personal relationship that could inappropriately influence/bias this work.

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Authors and Affiliations

  1. Department of Clinical Oncology and Nuclear Medicine, Mansoura University Hospitals, Mansoura, Egypt

    Hany Eldeeb, Iman Awad & Osman Elhanafy

  2. Department of Surgery, Mansoura University Hospitals, Mansoura, Egypt

    Hany Eldeeb, Iman Awad & Osman Elhanafy

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  1. Hany Eldeeb
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  2. Iman Awad
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  3. Osman Elhanafy
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Correspondence to Hany Eldeeb.

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Eldeeb, H., Awad, I. & Elhanafy, O. Hypofractionation in post-mastectomy breast cancer patients: seven-year follow-up. Med Oncol 29, 2570–2576 (2012). https://doi.org/10.1007/s12032-012-0192-1

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  • DOI: https://doi.org/10.1007/s12032-012-0192-1

Keywords

  • Breast cancer
  • Mastectomy
  • Radiotherapy
  • Fractionation