Vol 26, No 6 (2021)
Research paper
Published online: 2021-10-04

open access

Page views 6171
Article views/downloads 388
Get Citation

Connect on Social Media

Connect on Social Media

Hypofractionated radiotherapy in breast cancer: a 10-year single institution experience

Gabriel Faria Najas1, Silvia Radwanski Stuart1, Gustavo Nader Marta1, Lorine Arias Bonifácio Teixeira1, Vinicius de Carvalho Gico1, Alexandre Ruggieri Serante1, Geovanne Pedro Mauro1, Mateus Costa Lima1, Heloisa de Andrade Carvalho1
Rep Pract Oncol Radiother 2021;26(6):920-927.

Abstract

Background: Moderately post-operative hypofractionated radiotherapy (HYPO-RT) for breast cancer is a safe and effective strategy as seen in large prospective trials. This study aimed to assess overall and disease-free survivals, local control, and acute and late toxicities in patients treated with HYPO-RT.

Materials and methods: Data from patients submitted to post-operative HYPO-RT, with or without boost, were evaluated retrospectively. Demographic, disease, and treatment characteristics were collected.

Results: From March 2009 to December 2016, 393 patients were treated. Breast-conserving surgery was performed in 94.7%, immediate reconstruction after mastectomy in 6 (1.5%). Most patients (91.2%) had initial stage (0 to IIA), and chemotherapy was performed in 42.0%, HYPO-RT was mainly performed in 15 or 16 daily fractions of 267 cGy and 265 cGy, respectively. The median follow-up was 5.7 years. There were 25 deaths (6.4%) and 17 (4.3%) local recurrences. At 5 and 10 years, the overall survival, local control, and disease-free survival were, respectively, 96.0% and 79.3%, 99.2% and 94.9%, 96.6%, and 91.9%. Acute grade 3 or 4 dermatitis was observed in 0.9%. Late grade 1 or 2 occurred in less than 3% of the patients.

Conclusion: HYPO-RT is a safe and effective radiotherapy regimen with excellent disease control and overall survival rates, with low acute and late toxicity rates.

Article available in PDF format

View PDF Download PDF file

References

  1. Whelan T, MacKenzie 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(15): 1143–1150.
  2. 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 randomised trial. Radiother Oncol. 2005; 75(1): 9–17.
  3. Owen J, Ashton A, Bliss J, 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 randomised trial [published correction appears in Lancet Oncol. 2006 Aug;7(8):620]. Lancet Oncol. 2006; 7(6): 467–471.
  4. Bentzen SM, Agrawal RK, Aird EG. START Trialists' Group. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. The Lancet Oncology. 2008; 9(4): 331–341.
  5. Bentzen SM, Agrawal RK, Aird EGA, et al. START Trialists' Group, START Trialists' Group. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008; 371(9618): 1098–1107.
  6. 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.
  7. Haviland JS, Owen JR, Dewar JA, et al. START Trialists' Group. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013; 14(11): 1086–1094.
  8. 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.
  9. Offersen BV, Alsner J, Nielsen HM, et al. Danish Breast Cancer Group Radiation Therapy Committee. Hypofractionated Versus Standard Fractionated Radiotherapy in Patients With Early Breast Cancer or Ductal Carcinoma In Situ in a Randomized Phase III Trial: The DBCG HYPO Trial. J Clin Oncol. 2020; 38(31): 3615–3625.
  10. Wang SL, Fang H, Hu C, et al. Hypofractionated Versus Conventional Fractionated Radiotherapy After Breast-Conserving Surgery in the Modern Treatment Era: A Multicenter, Randomized Controlled Trial From China. J Clin Oncol. 2020; 38(31): 3604–3614.
  11. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995; 31(5): 1341–1346.
  12. Darby S, McGale P, Correa C, et al. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011; 378(9804): 1707–1716.
  13. McGale P, Taylor C, Correa C, et al. EBCTCG (Early Breast Cancer Trialists' Collaborative Group). Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014; 383(9935): 2127–2135.
  14. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  15. Smith BD, Bentzen SM, Correa CR, et al. Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Int J Radiat Oncol Biol Phys. 2011; 81(1): 59–68.
  16. Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018; 8(3): 145–152.
  17. Freitas NM, Rosa AA, Marta GN, et al. SBRT, Brazilian Society of Radiotherapy. Recommendations for hypofractionated whole-breast irradiation. Rev Assoc Med Bras (1992). 2018; 64(9): 770–777.
  18. Marta GN, Coles C, Kaidar-Person O, et al. The use of moderately hypofractionated post-operative radiation therapy for breast cancer in clinical practice: A critical review. Crit Rev Oncol Hematol. 2020; 156: 103090.
  19. Murray Brunt A, Haviland JS, Wheatley DA, et al. FAST-Forward Trial Management Group. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet. 2020; 395(10237): 1613–1626.