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A unique hypofractionated radiotherapy schedule with 51.3 Gy in 18 fractions three times per week for early breast cancer: outcomes including local control, acute and late skin toxicity

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Abstract

Aim

Evaluation of local control and acute and late toxicity regarding a hypofractionated RT schedule for breast cancer patients.

Methods and Materials

Between October 2007 and October 2009, 80 women with early breast cancer were treated by 42.75 Gy in 15 fractions over 5 weeks. This treatment involved three fractions per week (Monday–Wednesday–Friday). All patients received an additional boost dose to the tumor bed of 8.55 Gy in 3 fractions using 6 MV photons. The primary endpoint included any local recurrence in the treated breast. Secondary endpoint included acute and late radiation skin toxicity. The median follow-up time was 63 months (range 60–72). Radiation toxicity was graded according the RTOG/EORTC criteria.

Results

Neither local nor distant recurrence was noted in any patient during this 3-year follow-up. Grade 0, 1, 2 acute skin toxicity was observed in 56/80 (70.0 %), in 19/80 (23.8 %) and in 5/80 (6.3 %), respectively. Three months post-RT, toxicity grades 0, 1, 2 skin toxicity were 64/80 (80 %), 14/80 (17.5 %) and 2/80 (2.5 %), respectively. Late toxicity as grade 0, 1 was observed in 72/80 (90.0 %) and in 8/80 (10.0 %), respectively, 6 months post-RT, whereas after 1 year they were 78/80 (97.5 %) and 2/80 (2.5 %), respectively.

Conclusions

Preliminary results regarding skin reactions, cosmetic appearance and local control are consistent with published data that support the use of shorter fractionation schedules in early breast cancer patients after breast conservative surgery. Longer follow-up and a randomized prospective study stand in need for the extraction of safe conclusions.

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References

  1. Williams MV, Denekamp J, Fowler JF. A review of alpha/beta ratios for experimental tumours: implications for clinical studies of altered fractionation. Int J Radiat Oncol Biol Phys. 1985;11:87–96.

    Article  CAS  PubMed  Google Scholar 

  2. Rosenstein BS, Lymberis SC, Formenti SC. Biologic comparison of partial breast irradiation protocols. Int J Radiat Oncol Biol Phys. 2004;60:1394–404.

    Article  Google Scholar 

  3. Kurtz JM. The clinical radiobiology of breast cancer radiotherapy. Radiother Oncol. 2005;75:6–8.

    Article  PubMed  Google Scholar 

  4. Jones B, Dale RG, Deehan K, Hopkins KI, Morgan DAL. The role of biologically effective dose (BED) in clinical oncology. Clin Oncol. 2001;13:71–81.

    CAS  Google Scholar 

  5. 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  CAS  PubMed  Google Scholar 

  6. Yarnold J, Ashton A, Bliss J, et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomized trial. Radiother Oncol. 2005;75:9–17.

    Article  PubMed  Google Scholar 

  7. Owen JR, Ashton A, Bliss JM, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomize trial. Lancet Oncol. 2006;7:467–71.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  11. 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. 2008;15:86–92.

    Article  PubMed  Google Scholar 

  12. Livi L, Stefanacci M, Scoccianti S, et al. Adjuvant hypofractionated radiation therapy for breast cancer after conserving surgery. R Coll Radiol. 2007;19:120–4.

    Article  CAS  Google Scholar 

  13. Zygogianni AG, Kouloulias V, Armpilia C, Balafouta M, Antypas C, Kouvaris JR. The potential role of hypofractionated accelerated radiotherapy to cosmesis for stage I-II breast carcinoma: a prospective study. J BUON. 2011;16:58–63.

    CAS  PubMed  Google Scholar 

  14. Zygogianni AG, Kouvaris JR, Kouloulias V, Armpilia C, Antypas C, Vlachos L. Hypofractionated accelerated irradiation for stage I-II breast carcinoma: a phase II study. Breast J. 2010;16:337–8.

    Article  PubMed  Google Scholar 

  15. Whelan T, MacKenziew 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 

  16. Yarnold J, Bloomeld D, LeVay J. Prospective randomized trial testing 5.7 Gy and 6.0 Gy fractions of whole breast radiotherapy in women with early breast cancer (FAST) trial. Clin Oncol. 2004;16:S30.

    Google Scholar 

  17. The START ‘Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet. 2008;29:1098–107.

    Google Scholar 

  18. The START ‘Trialists’ Group. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomized trial. Lancet. 2008;9:331–41.

    Article  Google Scholar 

  19. International Commission on Radiation Units and Measurements. Prescribing, recording and reporting photon beam therapy, ICRU report 50. Bethesda: International Commission on Radiation Units and Measurements; 1993. p. 3–16.

    Google Scholar 

  20. International Commission on Radiation Units and Measurements. Prescribing, recording and reporting photon beam therapy, ICRU report 62. Bethesda: International Commission on Radiation Units and Measurements; 1999.

    Google Scholar 

  21. Wyatt M, Jones BJ, Dale RG. Radiotherapy treatment delays and their influence on tumour control achieved by various fractionation schedules. Br J Radiol. 2008;81:549–63.

    Article  CAS  PubMed  Google Scholar 

  22. Ramsey SD, Zeliadt SB, Richardson LC. Discontinuation of radiation treatment among Medicaid-enrolled women with local and regional stage breast cancer. Breast J. 2010;16:20–7.

    Article  PubMed  Google Scholar 

  23. Sanpaolo P, Barbieri P, Genovesi D, Fusco V, Cefaro GA. Biologically effective dose and breast cancer conservative treatment: is duration of radiation therapy really important? Breast Cancer Res Treat. 2012;134:81–7.

    Article  CAS  PubMed  Google Scholar 

  24. Qi XS, White J, Li XA. Is α/β for breast cancer really low? Radiother Oncol. 2011;100:282–8.

    Article  PubMed  Google Scholar 

  25. Thrapsanioti Z, Karanasiou I, Platoni K, et al. Transformation of physical DVHs to radiobiologically equivalent ones in hypofractionated radiotherapy analyzing dosimetric and clinical parameters: a practical approach for routine clinical practice in radiation oncology. Comput Math Methods Med. 2013;2013:713420. doi:10.1155/2013/713420.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bentzen S, Constine L, Deasy J, et al. Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An Introduction to the Scientific Issues. Int J Radiat Oncol Biol Phys. 2010;76(3):3–9.

    Article  Google Scholar 

  27. Haustermans K, Fowler J, Geboes K, et al. Relationship between potential doubling time (Tpot), labeling index and duration of DNA synthesis in 60 esophageal and 35 breast tumors: is it worthwhile to measure Tpot? Radiother Oncol. 1998;46:157–67.

    Article  CAS  PubMed  Google Scholar 

  28. Clarke M, Collins R, Darby S, et al. Viewpoint: local Recurrence and 15 Year Survival in Early Breast Cancer: An Important Meta-analysis. Lancet. 2005;366:2087–106.

    Article  CAS  PubMed  Google Scholar 

  29. Early Breast Cancer Trialists’ Collaborative Group. (EBCTCG). Favorable and unfavorable 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 

  30. Armpilia C, Antypas C, Zygogianni A, et al. A review on radiotherapy hypofractionated schedules for breast cancer treatment. J Radiother pract. 2011;10:201–8.

    Article  Google Scholar 

  31. Whelan TJ, Pignol J-P, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513–20.

    Article  CAS  PubMed  Google Scholar 

  32. Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10 year follow-up results of two 17 randomized controlled trials. Lancet Oncol. 2013;14(11):1086–94.

    Article  PubMed  Google Scholar 

  33. Agrawal RK, Alhasso A, Barrett-Lee PJ, et al. First results of the 17randomized UK FAST Trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015). Radiother Oncol. 2011;100(1):93e100.

    Google Scholar 

  34. Coles CE, Brunt AM, Wheatley D, Mukesh MB, Yarnold JR. Breast radiotherapy: less is more? Clin Oncol. 2013;25(2):127–34.

    Article  CAS  Google Scholar 

  35. Kirova YM, Campana F, Savignoni A, et al. Institut Curie Breast Cancer Study Group. Breast-conserving treatment in the elderly: long-term results of adjuvant hypofractionated and normofractionated radiotherapy. Int J Radiat Oncol Biol Phys. 2009;75(1):76–81.

    Article  PubMed  Google Scholar 

  36. Kouloulias VE. Quality assurance in radiotherapy. Eur J Cancer. 2003;39(4):415–22.

    Article  CAS  PubMed  Google Scholar 

  37. Donovan E, Bleakley N, Denholm E, et al. Breast Technology Group. Randomised trial of standard 2D radiotherapy (RT) versus intensity modulated radiotherapy (IMRT) in patients prescribed breast radiotherapy. Radiother Oncol. 2007;82(3):254–64.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Radiotherapy Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National University of Athens, Athens, Greece

    Kouloulias Vassilis, Gogalis Ioannis, Zygogianni Anna, Armpilia Christina, Antypas Christos, Kokakis John & Kouvaris John

  2. Radiotherapy Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National University of Athens, Rimini 1 Chaidari, 12462, Athens, Greece

    Kouloulias Vassilis

  3. 1st Obstetric and Gynecologic Clinic, Athens Medical School, Alexandra Hospital, Athens, Greece

    Koromperlis Porfyrios

  4. Microbiology Laboratory, Medical School, National University of Athens, Athens, Greece

    Gennimata Vassiliki

Authors
  1. Kouloulias Vassilis
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  2. Gogalis Ioannis
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  3. Zygogianni Anna
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  4. Armpilia Christina
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  8. Gennimata Vassiliki
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Correspondence to Kouloulias Vassilis.

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Vassilis, K., Ioannis, G., Anna, Z. et al. A unique hypofractionated radiotherapy schedule with 51.3 Gy in 18 fractions three times per week for early breast cancer: outcomes including local control, acute and late skin toxicity. Breast Cancer 24, 263–270 (2017). https://doi.org/10.1007/s12282-016-0697-0

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  • DOI: https://doi.org/10.1007/s12282-016-0697-0

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