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Whole-breast radiotherapy with shorter fractionation schedules following breast-conserving surgery: short-term morbidity and preliminary outcomes

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  • New trends in radiation therapy as a component of breast conserving therapy
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The success of whole-breast radiotherapy with shorter fractionation schedules following BCS has rarely been evaluated in Japanese women. Here we present the short-term morbidity and preliminary outcomes of the shorter fractionation regimen initiated at the Kawasaki Medical School Hospital in 2003.


Between January 2003 and December 2005, 248 patients (251 breasts) with breast cancer underwent short-course RT following BCS. The whole breast was irradiated with a total dose of 42.5–47.8 Gy in 16–20 fractions. Patients with positive margins received additional boost irradiation to the tumor bed of 10–13.3 Gy in 4–5 fractions using 4–11 MeV electrons. Adjuvant therapy was administered in 217 cases.


The median follow-up time was 26 months. The actuarial 4 year overall, cause specific, and disease-free survival rates were 96.7, 98.6, and 94.9%, respectively. Local recurrence was observed in one patient and distant metastases in four. The 4 year local control rate was 99.0%. A total of 221 patients developed radiation dermatitis (207 patients with grade 1, 14 patients with grade 2). The incidence of grade 2 dermatitis correlated with patient age. Radiation pneumonitis was observed in 15 patients (nine patients with grade 1, six with grade 2), two of whom developed BOOP. No difference was found in age, irradiated breast site, or use of boost irradiation, chemotherapy, and tamoxifen between those with and without pneumonitis.


The short fractionation regimen results in acceptable short-term morbidity. With limited follow-up, the incidence of recurrence in the treated breast was low.

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Breast-conserving therapy


Breast-conserving surgery


Union Internationale Contre lé Cancer


Bronchiolitis obliterans organizing pneumonia


Radiation therapy


Ontario Clinical Oncology Group


Computed tomography


Radiation Therapy Oncology Group


European Organization for Research and Treatment of Cancer


Radiation dermatitis


Radiation pneumonitis


Cyclophosphamide, methotrexate, and fluorouracil




Epirubicin and cyclophosphamide




Cyclophosphamide, doxorubicin, and fluorouracil


Doxorubicin and cyclophosphamide


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  1. Malmstrom P, Holmberg L, Anderson H, Mattsson J, Jonsson PE, Tennvall-Nittby L, Balldin G, Loven L, Svensson JH, Ingvar C, Moller T, Holmberg E, Wallgren A. Breast conservation surgery, with and without radiotherapy, in women with lymph node-negative breast cancer: a randomized clinical trial in a population with access to public mammography screening. Eur J Cancer. 2003;39:1690–7.

    Article  PubMed  CAS  Google Scholar 

  2. Liljegren G, Holmberg L, Bergh J, Lindgren A, Tabar L, Nordgren H, Adami HO. 10-year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol. 1999;17:2326–33.

    PubMed  CAS  Google Scholar 

  3. Renton SC, Gazet JC, Ford HT, Corbishley C, Sutcliffe R. The importance of the resection margin in conservative surgery for breast cancer. Eur J Surg Oncol. 1996;22:17–22.

    Article  PubMed  CAS  Google Scholar 

  4. Veronesi U, Salvadori B, Luini A, Greco M, Saccozzi R, del Vecchio M, Mariani L, Zurrida S, Rilke F. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomized trials on 1,973 patients. Eur J Cancer. 1995;31A:1574–9.

    Article  PubMed  CAS  Google Scholar 

  5. Forrest AP, Stewart HJ, Everington D, Prescott RJ, McArdle CS, Harnett AN, Smith DC, George WD. Randomized controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group. Lancet. 1996;348:708–13.

    Article  PubMed  CAS  Google Scholar 

  6. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  7. Clark RM, Whelan T, Levine M, Roberts R, Willan A, McCulloch P, Lipa M, Wilkinson RH, Mahoney LJ. Randomized clinical trial of breast irradiation following lumpectomy and axillary dissection for node-negative breast cancer: an update. Ontario Clinical Oncology Group. J Natl Cancer Inst. 1996;88:1659–64.

    Article  PubMed  CAS  Google Scholar 

  8. Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomized trials. Lancet. 2000;355:1757–70.

    Article  Google Scholar 

  9. Fowler JF. The linear-quadric formula and progress in fractionated radiotherapy. Br J Radiol. 1989;62:679–94.

    Article  PubMed  CAS  Google Scholar 

  10. Whelan T, MacKenzie R, Julian J, Levine M, Shelly W, Grimard L, Lada B, Lukka H, Perera F, Fyles A, Laukkanen E, Gulavita S, Benk V, Szechtman B. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94:1143–50.

    PubMed  Google Scholar 

  11. Sobin LH, Wittekind Ch, editors. International union against cancer (UICC), TNM classification of malignant tumours. 6th ed. New York: Wiley; 2002.

  12. The Japanese Breast Cancer Society. General rules for clinical and pathological recording of breast cancer. 14th ed. Tokyo: Kanehara; 2000. pp. 20–56.

    Google Scholar 

  13. Cox J, Stetz J, Pajak T. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–6.

    Article  PubMed  CAS  Google Scholar 

  14. Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin J, Cordier J. Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. Am J Respir Crit Care Med. 1998;158:1929–35.

    PubMed  CAS  Google Scholar 

  15. Ribeiro GG, Magee B, Swindell R, Harris M, Banerjee SS. The Christie Hospital breast conservation trial: an update at 8 years from inception. Clin Oncol. 1993;5:278–83.

    Article  CAS  Google Scholar 

  16. Ash DV, Benson EA, Sainsbury JR, Round C. Seven-year follow-up on 334 patients treated by breast conserving surgery and short course radical postoperative radiotherapy: a report of the Yorkshire breast cancer group. J Clin Oncol. 1995;7:93–6.

    Article  CAS  Google Scholar 

  17. Olivotto IA, Weir LM, Kim-Sing C, Bajdik CD, Trevisan CH, Doll CM, Lam WY, Basco VE, Jackson SM. Late cosmetic results of short fraction for breast conservation. Radiother Oncol. 1996;41:7–13.

    PubMed  CAS  Google Scholar 

  18. Yamada Y, Ackerman I, Franssen E, MacKenzie RG, Thomas G. Does the dose fractionation schedule influence local control of adjuvant radiotherapy for early stage breast cancer? Int J Radiat Oncol Biol Phys. 1999;44:99–104.

    Article  PubMed  CAS  Google Scholar 

  19. Shelley W, Brundage M, Hayter C, Paszat L, Zhou S, Mackillop W. A shorter fractionation schedule for postlumpectomy breast cancer patients. Int J Radiat Oncol Biol Phys. 2000;47:1219–28.

    Article  PubMed  CAS  Google Scholar 

  20. Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, Haviland J, Bentzen SM, Yornold JR. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomized trial. Lancet. 2006;7:467–71.

    Article  Google Scholar 

  21. Read PE, Ash DV, Thorogood J, Benson A. Short term morbidity and cosmesis following lumpectomy and radical radiotherapy for operable breast cancer. Clin Radiol. 1987;38:371–3.

    Article  PubMed  CAS  Google Scholar 

  22. Turesson I, Nyman J, Holmberg E, Odén A. Prognostic factors for acute and late skin reactions in radiotherapy patients. Int J Radiat Oncol Biol Phys. 1996;36:1065–75.

    Article  PubMed  CAS  Google Scholar 

  23. Yoden E, J Hiratsuka Y Imajyo. Radiation dermatitis and pneumonitis following breast conserving therapy. J Jpn Soc Ther Radiol Oncol. 2000;12:237–46 (in Japanese with English abstract).

    Google Scholar 

  24. Cherniack RM, Abrams J, Kalica AR. NHLBI workshop summary. Pulmonary disease associated with breast cancer therapy. Am J Respir Crit Care Med. 1994;150:1169–73.

    PubMed  CAS  Google Scholar 

  25. Lingos TI, Recht A, Vicini F, Abner A, Silver B, Harris JR. Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 1991;21:355–60.

    PubMed  CAS  Google Scholar 

  26. Epler GR. Bronchiolitis obliterans organizing pneumonia. Semin Respir Infect. 1995;10:65–77.

    PubMed  CAS  Google Scholar 

  27. Takigawa N, Segawa Y, Saeki T, Kataoka M, Ida M, Kishino D, Fujiwara K, Ohsumi S, Eguchi K, Takashima S. Bronchiolitis obliterans organizing syndrome in breast-conserving therapy for early breast cancer: radiation-induced lung toxicity. Int J Radiat Oncol Biol Phys. 2000;48:751–5.

    Article  PubMed  CAS  Google Scholar 

  28. Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stage I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys. 1979;5:257–61.

    PubMed  CAS  Google Scholar 

  29. Hamilton CS, Nield JM, Adler GF, Clingan PR. Breast appearance and function after breast conserving surgery and radiotherapy. Acta Oncol. 1990;29:291–5.

    Article  PubMed  CAS  Google Scholar 

  30. Dewar JA, Benhamou S, Benhamou E, Arriagada R, Petit JY, Fontaine F, Sarrazin D. Cosmetic results following lumpectomy, axillary dissection, radiotherapy for breast cancers. Radiother Oncol. 1988;12:273–80.

    Article  PubMed  CAS  Google Scholar 

  31. Sarrazin D, Le MG, Arrigada R, Contesso G, Fontaine F, Spielmann M, Rochard F, Le Chevalier T, Lacour J. Ten-year results of a randomized trial comparing a conservative treatment to mastectomy in early breast cancer. Radiother Oncol. 1989;14:177–84.

    Article  PubMed  CAS  Google Scholar 

  32. Van Limbergen E, Rijnders A, van der Schueren E, Lerut T, Christiaens R. Cosmetic evaluation of breast conserving treatment for mammary cancer. 2. A quantitative analysis of the influence of radiation dose, fractionation schedules, surgical treatment techniques on cosmetic results. Radiother Oncol. 1989;16:253–67.

    Article  PubMed  Google Scholar 

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Correspondence to Osamu Fujii.

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Fujii, O., Hiratsuka, J., Nagase, N. et al. Whole-breast radiotherapy with shorter fractionation schedules following breast-conserving surgery: short-term morbidity and preliminary outcomes. Breast Cancer 15, 86–92 (2008).

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