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

  • Special Feature: Original Article
  • New trends in radiation therapy as a component of breast conserving therapy
  • Published:
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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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Abbreviations

BCT:

Breast-conserving therapy

BCS:

Breast-conserving surgery

UICC:

Union Internationale Contre lé Cancer

BOOP:

Bronchiolitis obliterans organizing pneumonia

RT:

Radiation therapy

OCOG:

Ontario Clinical Oncology Group

CT:

Computed tomography

RTOG:

Radiation Therapy Oncology Group

EORTC:

European Organization for Research and Treatment of Cancer

RD:

Radiation dermatitis

RP:

Radiation pneumonitis

CMF:

Cyclophosphamide, methotrexate, and fluorouracil

TOR:

Toremifene

EC:

Epirubicin and cyclophosphamide

PAC:

Paclitaxel

CAF:

Cyclophosphamide, doxorubicin, and fluorouracil

AC:

Doxorubicin and cyclophosphamide

UFT:

Tegafur uracil

WBRT:

Whole-breast radiotherapy

DCIS:

Ductal carcinoma in situ

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Author information

Author notes

  1. Osamu Fujii

    Present address: Department of Radiation Oncology, Hyogo Cancer Center, 13-70 Kitaojicho, Akashi, 673-8558, Japan

Authors and Affiliations

  1. Department of Radiation Oncology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Osamu Fujii, Jyunichi Hiratsuka, Naomi Nagase, Ryuji Tokiya, Eisaku Yoden & Yoshinari Imajyo

  2. Department of Breast and Thyroid Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Hiroshi Sonoo

  3. Department of Surgery, Kurashiki Medical Center, 250 Bakuroucho, Kurashiki, Okayama, 710-8522, Japan

    Nobutaka Murashima & Shigemichi Iha

Authors
  1. Osamu Fujii
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  2. Jyunichi Hiratsuka
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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). https://doi.org/10.1007/s12282-007-0010-3

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  • DOI: https://doi.org/10.1007/s12282-007-0010-3

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