A phase II study of 2-weeks of adjuvant whole breast/chest wall and/or regional nodal radiotherapy in patients with breast cancer

Publication date: Available online 16 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Budhi Singh Yadav, Suresh C. Sharma
BackgroundTo report results in terms of feasibility and early toxicity of hypofractionated adjuvant whole breast/chest wall and/or regional nodal radiotherapy in patients with breast cancer.Materials & methods: Between June 2013 and October 2014, 50 patients with breast cancer, post mastectomy or after breast conservation surgery (BCS) were prospectively included. The trial was approved by institutional ethics committee and registered with ClinicalTrials.gov, number XXXX. Patients were planned on simulator with two tangential fields to breast/chest wall and incident field to supraclavicular fossa. Radiotherapy dose delivered was 34Gy/10fractions /2 weeks followed by a boost of 10Gy/5fractions/1wk in cases with BCS. Acute skin toxicities were recorded during and after treatment according to RTOG acute radiation toxicity scoring criteria. The primary objective was to obtain estimates of rates of acute toxicities and cosmetic outcomes that could be used to design a subsequent phase III comparative study. Acute skin and late toxicities were recorded during and after treatment. Cosmetic outcomes were assessed before and after treatment and then on regular follow up. Cost benefit analysis was also done and compared with standard treatment of 35Gy/15fractions/3weeks.ResultsMedian follow up was 39 months (range 14-48 months). Mean age was 51 years (range 26-75). Left sided tumor was seen in 25(50%) patients. Total mastectomy with axillary clearance (TMAC) was done in 40(80%) and BCS in 10(20%) patients. Acute grade 2 and 3 skin toxicity was seen in 16(32%) and 1(2%) patients, respectively. In patients with BCS, grade 2 skin and subcutaneous toxicity was seen in 2(20%) and 1(10%) patients, respectively. Grade 2 edema was seen in 1(10%) patient. Cosmesis was excellent/good in 8(80%) and fair/poor in 2(20%) patients. On cost benefit analysis there was significant less financial burden on the patients with 2 weeks treatment. Disease free and overall survival at 3 years was 94% and 96%, respectively.ConclusionHypofractionated radiotherapy in 2 weeks appears to be feasible in patients with breast cancer and was associated with acute and late skin toxicity profiles that are similar to what has been observed with 3 weeks of treatment. The financial burden on the patient and family may be reduced with 2 weeks of treatment. Long-term follow up and a prospective comparative study is needed to strengthen these results. Hypofractionation may help radiation centers worldwide to meet the growing need for radiation in breast cancer, particularly in developing countries where resources are limited and patients have to travel for long distance for treatment.



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