Vol 27, No 2 (2022)
Research paper
Published online: 2022-03-09

open access

Page views 4576
Article views/downloads 325
Get Citation

Connect on Social Media

Connect on Social Media

Hypofractionated radiotherapy in young versus older women with breast cancer: a retrospective study from India

Budhi Singh Yadav1, Deepak Das1, Anshuma Bansal2, Divya Dahiya3
Rep Pract Oncol Radiother 2022;27(2):281-290.


Background: Young women with breast cancer (BC) are not represented in the trials on hypofractionation. In this study we compared outcomes in young patients with BC to their older counterparts treated with hypofractionated radiotherapy (RT) in a regional cancer centre in India.

Materials and methods: Between January 1990 to December 2010, women with BC, treated with hypofractionated RT dose of 35–40 Gy/15#/3 weeks were divided into two groups, ≤ 35 years and > 35 years. Outcomes compared were locoregional recurrence rate (LRR), locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), overall survival (OS) and toxicities. LRRFS, DFS and OS were estimated using the Kaplan-Meier method.

Results: Of total 2244 patients, 359 were ≤ 35 years of age and 1885 were > 35 years. Patient and disease characteristics were comparable between the two groups, except that comorbidities were significantly higher in the > 35 years age group, more patients aged ≤ 35 years had nodal N3 disease, received chemotherapy and RT to internal mammary nodes and more patients in the > 35 years group received hormonal therapy. Median follow up was 10 years (range 1–30 years). LRR and distant metastases were comparable between the two groups. However, synchronous LRR and distant metastases were significantly higher in the ≤ 35 years group 18 (5.1%) as compared to the > 35 years group 39 (2.1%) with p = 0.018. Estimated 10-year LRRFS, DFS and OS were 92% vs. 94% (p = 0.95), 68% vs. 73%(p = 0.058) and 78% vs. 76% (p = 0.10) in ≤ 35 years and > 35 years, respectively. OS for stage 1 was comparable between the two groups. However, for stage 2 and 3 it was 77% vs. 82%(p = 0.048) and 53% vs. 62% (p = 0.045) in the ≤ 35 years and > 35 years group, respectively. Acute and late toxicity were similar in the two groups.

Conclusion: Young BC patients had higher LRR and distant metastases. LRRFS, DFS and toxicities were comparable between the two groups. However, OS was poorer in young BC patients with stage 2 and 3 disease.

Article available in PDF format

View PDF Download PDF file


  1. National Center for Health Statistics. http://www.cdc.gov/nchs/.
  2. Kroman N, Jensen MB, Wohlfahrt J, et al. Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ. 2000; 320(7233): 474–478.
  3. Maggard M, O'Connell J, Lane K, et al. Do young breast cancer patients have worse outcomes? J Surg Res. 2003; 113(1): 109–113.
  4. Bharat A, Aft RL, Gao F, et al. Patient and tumor characteristics associated with increased mortality in young women (< or =40 years) with breast cancer. J Surg Oncol. 2009; 100(3): 248–251.
  5. Fredholm H, Eaker S, Frisell J, et al. Breast cancer in young women: poor survival despite intensive treatment. PLoS One. 2009; 4(11): e7695.
  6. Venigalla S, Guttmann DM, Jain V, et al. Trends and Patterns of Utilization of Hypofractionated Postmastectomy Radiotherapy: A National Cancer Database Analysis. Clin Breast Cancer. 2018; 18(5): e899–e908.
  7. Gnerlich JL, Deshpande AD, Jeffe DB, et al. Elevated breast cancer mortality in women younger than age 40 years compared with older women is attributed to poorer survival in early-stage disease. J Am Coll Surg. 2009; 208(3): 341–347.
  8. Adami HO, Malker B, Holmberg L, et al. The relation between survival and age at diagnosis in breast cancer. N Engl J Med. 1986; 315(9): 559–563.
  9. Fredholm H, Magnusson K, Lindström LS, et al. Long-term outcome in young women with breast cancer: a population-based study. Breast Cancer Res Treat. 2016; 160(1): 131–143.
  10. Haviland JS, Mannino M, Griffin C, et al. START Trialists' Group. Late normal tissue effects in the arm and shoulder following lymphatic radiotherapy: Results from the UK START (Standardisation of Breast Radiotherapy) trials. Radiother Oncol. 2018; 126(1): 155–162.
  11. Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010; 362(6): 513–520.
  12. Wang SL, Fang H, Song YW, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol. 2019; 20(3): 352–360.
  13. Sheridan W, Scott T, Caroline S, et al. Breast cancer in young women: have the prognostic implications of breast cancer subtypes changed over time? Breast Cancer Res Treat. 2014; 147(3): 617–629.
  14. Smith IC, Heys SD, Hutcheon AW, et al. Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. J Clin Oncol. 2002; 20(6): 1456–1466.
  15. Loibl S, Jackisch C, Lederer B, et al. Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials. Breast Cancer Res Treat. 2015; 152(2): 377–387.
  16. Loibl S, Jackisch C, Lederer B, et al. Outcome after neoadjuvant chemotherapy in young breast cancer patients: a pooled analysis of individual patient data from eight prospectively randomized controlled trials. Breast Cancer Res Treat. 2015; 152(2): 377–387.
  17. Ademuyiwa FO, Gao F, Hao L, et al. US breast cancer mortality trends in young women according to race. Cancer. 2015; 121(9): 1469–1476.
  18. Azim HA, Michiels S, Bedard PL, et al. Elucidating prognosis and biology of breast cancer arising in young women using gene expression profiling. Clin Cancer Res. 2012; 18(5): 1341–1351.
  19. Cancello G, Maisonneuve P, Rotmensz N, et al. Prognosis and adjuvant treatment effects in selected breast cancer subtypes of very young women (<35 years) with operable breast cancer. Ann Oncol. 2010; 21(10): 1974–1981.
  20. Morrison DH, Rahardja D, King E, et al. Tumour biomarker expression relative to age and molecular subtypes of invasive breast cancer. Br J Cancer. 2012; 107(2): 382–387.
  21. Johnson RH, Hu P, Fan C, et al. Gene expression in "young adult type" breast cancer: a retrospective analysis. Oncotarget. 2015; 6(15): 13688–13702.
  22. Liao S, Hartmaier RJ, McGuire KP, et al. The molecular landscape of premenopausal breast cancer. Breast Cancer Res. 2015; 17: 104.
  23. Han W, Kang SoY. Korean Breast Cancer Society. Relationship between age at diagnosis and outcome of premenopausal breast cancer: age less than 35 years is a reasonable cut-off for defining young age-onset breast cancer. Breast Cancer Res Treat. 2010; 119(1): 193–200.
  24. Albain KS, Allred DC, Clark GM. Breast cancer outcome and predictors of outcome: are there age differentials? J Natl Cancer Inst Monogr. 1994; 16 Suppl 2(16): 35–42.
  25. Francis PA, Pagani O, Fleming GF, et al. SOFT and TEXT Investigators and the International Breast Cancer Study Group. Tailoring Adjuvant Endocrine Therapy for Premenopausal Breast Cancer. N Engl J Med. 2018; 379(2): 122–137.
  26. Yadav BS, Bansal A, Kuttikat PG, et al. Late-term effects of hypofractionated chest wall and regional nodal radiotherapy with two-dimensional technique in patients with breast cancer. Radiat Oncol J. 2020; 38(2): 109–118.
  27. Yadav BS, Sharma SC. A Phase 2 Study of 2 Weeks of Adjuvant Whole Breast/Chest Wall and/or Regional Nodal Radiation Therapy for Patients With Breast Cancer. Int J Radiat Oncol Biol Phys. 2018; 100(4): 874–881.

Reports of Practical Oncology and Radiotherapy