Vol 26, No 1 (2021)
Research paper
Published online: 2021-01-22

open access

Page views 823
Article views/downloads 719
Get Citation

Connect on Social Media

Connect on Social Media

A radiobiological comparison of hypo-fractionation versus conventional fractionation for breast cancer 3D-conformal radiation therapy

Arezoo Kazemzadeh1, Iraj Abedi2, Alireza Amouheidari3, Atefeh Shirvany4
Rep Pract Oncol Radiother 2021;26(1):86-92.

Abstract

Background: The present research was aimed to compare the toxicity and effectiveness of conventional fractionated radiotherapy versus hypo-fractionated radiotherapy in breast cancer utilizing a radiobiological model.

Materials and methods: Thirty-five left-sided breast cancer patients without involvement of the supraclavicular and axillary lymph nodes (with the nodal stage of N0) that had been treated with conventional or hypo-fractionated were incorporated in this study. A radiobiological model was performed to foretell normal tissue complication probability (NTCP) and tumor control probability (TCP).

Results: The data represented that TCP values for conventional and hypo-fractionated regimens were 99.16 ± 0.09 and 95.96 ± 0.48, respectively (p = 0.00). Moreover, the NTCP values of the lung for conventional and hypo-fractionated treatment were 0.024 versus 0.13 (p = 0.035), respectively. Also, NTCP values of the heart were equal to zero for both regimens.

Conclusion: In summary, hypo-fractionated regimens had comparable efficacy to conventional fraction radiation therapy in the case of dosimetry parameters for patients who had left breast cancer. But, utilizing the radiobiological model, conventional fractionated regimens presented better results compared to hypo-fractionated regimens.

 

Article available in PDF format

View PDF Download PDF file

References

  1. Bolukbasi Y, Selek U. Modern Radiotherapy Era in Breast Cancer. In: Pham PV, Selek U. ed. Breast Cancer: From Biology to Medicine. IntechOpen, London 2017: 269.
  2. James M, Swadi S, Yi Ma, et al. Ischaemic heart disease following conventional and hypofractionated radiation treatment in a contemporary breast cancer series. J Med Imaging Radiat Oncol. 2018; 62(3): 425–431.
  3. Kawaguchi H, Tsujino K, Miki M, et al. Patient preference study comparing hypofractionated versus conventionally fractionated whole-breast irradiation after breast-conserving surgery. Jpn J Clin Oncol. 2019; 49(6): 545–553.
  4. Fragkandrea I, Kouloulias V, Mavridis P, et al. Radiation induced pneumonitis following whole breast radiotherapy treatment in early breast cancer patients treated with breast conserving surgery: a single institution study. Hippokratia. 2013; 17(3): 233–238.
  5. Khan M, Siddiqui SA, Gupta MK, et al. Normal Tissue Complications following Hypofractionated Chest Wall Radiotherapy in Breast Cancer Patients and Their Correlation with Patient, Tumor, and Treatment Characteristics. Indian J Med Paediatr Oncol. 2017; 38(2): 121–127.
  6. Chan EK, Woods R, Virani S, et al. Long-term mortality from cardiac causes after adjuvant hypofractionated vs. conventional radiotherapy for localized left-sided breast cancer. Radiother Oncol. 2015; 114(1): 73–78.
  7. Hostova B, Matula P, Dubinsky P. Prediction of toxicities of prostate cancer radiotherapy. Neoplasma. 2016; 63(1): 163–168.
  8. Kouloulias V, Mosa E, Zygogianni A, et al. A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer. Breast Care (Basel). 2016; 11(5): 328–332.
  9. Sukhikh ES, Sukhikh LG, Taletsky AV, et al. Influence of SBRT fractionation on TCP and NTCP estimations for prostate cancer. Phys Med. 2019; 62: 41–46.
  10. Sun Y, Yu XL, Luo W, et al. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Radiother Oncol. 2014; 110(3): 390–397.
  11. White J, Tai A, Arthur S, et al. Breast Cancer Atlas for Radiation Therapy Planning: Consensus Definitions. https://www.nrgoncology.org/Portals/0/Scientific%20Program/CIRO/Atlases/BreastCancerAtlas_corr.pdf?ver=2018-04-18-144201-270 (October, 2019).
  12. Gay HA, Niemierko A. A free program for calculating EUD-based NTCP and TCP in external beam radiotherapy. Phys Med. 2007; 23(3-4): 115–125.
  13. Sanchez-Nieto B, Nahum AE. BIOPLAN: software for the biological evaluation of. Radiotherapy treatment plans. Med Dosim. 2000; 25(2): 71–76.
  14. Zhou ZR, Mei X, Chen XX, et al. Systematic review and meta-analysis comparing hypofractionated with conventional fraction radiotherapy in treatment of early breast cancer. Surg Oncol. 2015; 24(3): 200–211.
  15. Dearnaley D, Syndikus I, Mossop H, et al. CHHiP Investigators. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016; 17(8): 1047–1060.
  16. Budach W, Bölke E, Matuschek C. Hypofractionated Radiotherapy as Adjuvant Treatment in Early Breast Cancer. A Review and Meta-Analysis of Randomized Controlled Trials. Breast Care (Basel). 2015; 10(4): 240–245.
  17. Miller AB, Wall C, Baines CJ, et al. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014; 348: g366.
  18. Barnett GC, Coles CE, Elliott RM, et al. Independent validation of genes and polymorphisms reported to be associated with radiation toxicity: a prospective analysis study. Lancet Oncol. 2012; 13(1): 65–77.
  19. Akl F, Khater A. Hypofractionated versus Conventionally Fractionated Radiotherapy in Post-Mastectomy Breast Cancer Patients. J Cancer Ther. 2018; 09(11): 941–954.
  20. De Felice F, Ranalli T, Musio D, et al. Relation between Hypofractionated Radiotherapy, Toxicity and Outcome in Early Breast Cancer. Breast J. 2017; 23(5): 563–568.
  21. Gloi A. A Broad Evaluation of Left Breast Radiotherapy. Am J Biomed Sci. 2019: 152–171.
  22. Hegemann NS, Guckenberger M, Belka C, et al. Hypofractionated radiotherapy for prostate cancer. Radiat Oncol. 2014; 9: 275.
  23. Mazonakis M, Stratakis J, Lyraraki E, et al. Risk of contralateral breast and ipsilateral lung cancer induction from forward-planned IMRT for breast carcinoma. Phys Med. 2019; 60: 44–49.
  24. Gokula K, Earnest A, Wong LC. Meta-analysis of incidence of early lung toxicity in 3-dimensional conformal irradiation of breast carcinomas. Radiat Oncol. 2013; 8: 268.
  25. Duane FK, McGale P, Brønnum D, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med. 2013; 368(11): 987–998.
  26. Graham MV, Purdy JA, Emami B, et al. Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC). Int J Radiat Oncol Biol Phys. 1999; 45(2): 323–329.



Reports of Practical Oncology and Radiotherapy