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Rajan J, Kr R, Sara George P, Arjunan A, Balakrishnan P, Augustine P, Sarah Mathew B. A Comparison Between Sequential Conventional and Hypofractionated Boost Following Whole-Breast Radiotherapy: A Propensity Score-Matched Analysis. Cureus 2023; 15:e46913. [PMID: 37954819 PMCID: PMC10639086 DOI: 10.7759/cureus.46913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The majority of local relapses after breast conservation therapy occur in the proximity of the primary lesion. Studies have shown that boost radiotherapy (RT) following conventional whole-breast radiotherapy (WBRT) of 50 Gy in five weeks improves outcomes. Boost RT also increases the risk of moderate skin reactions and fibrosis. The ideal boost RT dose and timing (sequential versus simultaneous) after hypofractionated radiotherapy schedules remain unclear. This retrospective propensity score-matched analysis assessed the outcome of sequential hypofractionated boost compared to conventional fractionated boost. METHODS The study was approved by the Institutional Review Board of the Regional Cancer Centre, Thiruvananthapuram, India. Patients with stage I-III breast cancer who have received adjuvant radiotherapy with a sequential boost of either hypofractionated RT (8 Gy in three fractions) or conventional fractionated RT (10 Gy in five fractions) after conservative breast surgery were identified from the radiotherapy planning records and included in this study. A 1:1 case matching was performed using a propensity score incorporating four known prognostic factors, namely, clinical and pathological composite stage, tumor grade, tumor biology (based on estrogen and/or progesterone and HER2 neu expression), and boost technique, which may have an impact on acute toxicity to make the two boost groups more homogenous. RESULTS After propensity score matching (PSM), there were a total of 166 patients, with 83 patients each in both conventional and hypofractionated boost RT groups. The median follow-up period was 30.7 months. At two years, locoregional recurrence-free survival (LRFS) was 98.8% in both groups. Disease-free survival (DFS) at two years for the hypofractionated group and conventional group was 91.5% and 96.3% (hazard ratio (HR): 2.5, 95% confidence interval (CI): 0.664-9.4, p = 0.161), respectively, with no statistically significant difference. Patients with grade 3 tumors who received hypofractionated boost had a statistically significant increased risk of recurrence (DFS: 88.9% versus 100%, HR: 60.559, 95% CI: 0.138-26613.2, p = 0.011). The overall survival (OS) at two years was 100% in both groups. There was no difference in acute skin toxicity between the two groups. CONCLUSION The present interim analysis shows similar locoregional recurrence-free survival, overall survival, and disease-free survival and acute skin toxicity for hypofractionated boost RT of 8 Gy in three fractions compared to the conventional boost of 10 Gy in five fractions. Hypofractionated boost is a feasible alternative option following hypofractionated whole-breast radiotherapy for women with breast conservation treatment. However, longer follow-up is required before forming definite conclusions.
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Affiliation(s)
- Jewel Rajan
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, IND
| | - Rajeev Kr
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, IND
| | - Preethi Sara George
- Department of Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram, IND
| | - Asha Arjunan
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, IND
| | - Priya Balakrishnan
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, IND
| | - Paul Augustine
- Department of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, IND
| | - Beela Sarah Mathew
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, IND
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Oses G, Barreto TD, Cases C, Muñoz-Guglielmetti D, Antelo G, Mollà M. Hypofractionated whole breast irradiation in association with hypofractionated or normofractionated boost to the tumor bed in early breast cancer: tolerance and efficacy analysis. Clin Transl Oncol 2023:10.1007/s12094-023-03124-6. [PMID: 36947361 DOI: 10.1007/s12094-023-03124-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/11/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND The boost to the tumor bed improves local control in breast cancer and it is an important part of the breast conserving therapy. However, information about the use of a hypofractionated boost is sparse, thus further studies are needed. We conducted a retrospective study with the aim of comparing hypofractionated boost (HB) and normofractionated boost (NB) on skin toxicity and local control. MATERIALS AND METHODS A total of 96 women with early breast cancer undergoing breast-conserving surgery and hypofractionated whole breast irradiation (WBI) were retrospectively analyzed divided into hypofractionated boost group and conventional fractionation boost group. Forty-nine patients were treated with NB with 16 Gy in 8 fractions and 47 patients were treated with HB with 13.35 Gy in 5 fractions. We examined acute and chronic toxicity with CTCAE version 5. RESULTS The median follow-up was 49.5 months (26-67). Median age was 57 years (36-82). Sixty-six patients (68.7%) were younger than 60 years at the time of boost and 30 (31.2%) were older than 60 years who received the boost due to poor prognostic factors. No differences were found between the two groups in terms of patient, tumor or treatment characteristics. Grade 2 acute skin toxicity was 6.3% in the NB group and 4.2% in the HB group. Chronic skin induration was 4.2% in the NB group and 1% in the HB group. They did not show grade 3 skin toxicity. There were also no differences in acute or late skin toxicity between the two groups. No local recurrences were evidenced. CONCLUSIONS Hypofractionated WBI associated with HB treatment is a viable option in the management of conservative breast therapy given the good tolerance and similar local control.
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Affiliation(s)
- Gabriela Oses
- Department of Radiation Oncology of Hospital Clinic, Calle Villarroel, 170, 08036, Barcelona, Spain.
| | - Tanny Daniela Barreto
- Department of Radiation Oncology of Hospital Clinic, Calle Villarroel, 170, 08036, Barcelona, Spain
| | - Carla Cases
- Department of Radiation Oncology of Hospital Clinic, Calle Villarroel, 170, 08036, Barcelona, Spain
| | - Diego Muñoz-Guglielmetti
- Department of Radiation Oncology of Hospital Clinic, Calle Villarroel, 170, 08036, Barcelona, Spain
| | - Gabriela Antelo
- Department of Radiation Oncology of Hospital Clinic, Calle Villarroel, 170, 08036, Barcelona, Spain
| | - Meritxell Mollà
- Department of Radiation Oncology of Hospital Clinic, Calle Villarroel, 170, 08036, Barcelona, Spain
- Department of Clinical Foundations, University of Barcelona, Barcelona, Spain
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Sayan M, Kilic S, Zhang Y, Liu B, Jan I, George M, Kumar S, Haffty B, Ohri N. Early Toxicity and Patient-Reported Cosmetic Outcomes in Patients Treated With Adjuvant Proton-Based Radiotherapy After Breast-Conserving Surgery. Clin Breast Cancer 2023; 23:176-180. [PMID: 36529604 DOI: 10.1016/j.clbc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION To evaluate the dosimetric data, early toxicity, and patient-reported cosmetic outcomes in breast cancer patients treated with adjuvant proton-based radiotherapy (RT) after breast-conserving surgery. MATERIALS AND METHODS We performed a retrospective review of our institutional database to identify breast cancer patients treated with breast-conserving surgery followed by proton-based RT from 2015 to 2020. Patient-reported cosmetic outcomes were graded as excellent, good, fair, or poor. Early toxicity outcomes were graded by the treating physician during treatment. Dose-volume histograms were reviewed to obtain dosimetry data. RESULTS We identified 21 patients treated with adjuvant proton-based RT. Median whole breast dose delivered was 46.8 Gy (range, 40.0-50.4 Gy). Target volumes included the regional lymph nodes in 17 patients (81%). Seventeen patients (81%) received a lumpectomy boost. The median planning target volume V95 was 94% (range, 77%-100%), V100 71% (range, 60%-97%), V110 2% (range 0%-18%), and median max point dose was 115% (range, 105%-120%). The median ipsilateral breast V105 was 367.3 cc (range, 0-1172 cc) and V110 was 24.1 cc (range, 0-321.3 cc). Grade 2 and 3 dermatitis occurred in 62% and 14% of patients, respectively. Grade 2 and 3 pain was reported by 33% and 10% of patients, respectively. Median follow-up at the time of cosmetic evaluation was 27 months (range, 5-42 months). Four patients (21%) reported fair cosmetic outcome and 15 patients (79%) reported good or excellent cosmetic outcome. No poor cosmesis was reported. CONCLUSION Adjuvant proton-based radiotherapy after breast-conserving surgery is well tolerated with acceptable rates of acute toxicities and a high rate of good-to-excellent patient-reported cosmetic outcomes.
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Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard University, Boston, MA.
| | - Sarah Kilic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Yin Zhang
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Bo Liu
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Imraan Jan
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Mridula George
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Shicha Kumar
- Department of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Bruce Haffty
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Nisha Ohri
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
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The Role of Hypofractionation in Proton Therapy. Cancers (Basel) 2022; 14:cancers14092271. [PMID: 35565400 PMCID: PMC9104796 DOI: 10.3390/cancers14092271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 12/07/2022] Open
Abstract
Hypofractionated radiotherapy is an attractive approach for minimizing patient burden and treatment cost. Technological advancements in external beam radiotherapy (EBRT) delivery and image guidance have resulted in improved targeting and conformality of the absorbed dose to the disease and a reduction in dose to healthy tissue. These advances in EBRT have led to an increasing adoption and interest in hypofractionation. Furthermore, for many treatment sites, proton beam therapy (PBT) provides an improved absorbed dose distribution compared to X-ray (photon) EBRT. In the past 10 years there has been a notable increase in reported clinical data involving hypofractionation with PBT, reflecting the interest in this treatment approach. This review will discuss the reported clinical data and radiobiology of hypofractionated PBT. Over 50 published manuscripts reporting clinical results involving hypofractionation and PBT were included in this review, ~90% of which were published since 2010. The most common treatment regions reported were prostate, lung and liver, making over 70% of the reported results. Many of the reported clinical data indicate that hypofractionated PBT can be well tolerated, however future clinical trials are still needed to determine the optimal fractionation regime.
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Freedman GM, Taunk NK. Hypofractionated Whole Breast Radiotherapy and Boost in Early-Stage Breast Cancer. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wang SL, Fang H, Hu C, Song YW, Wang WH, Jin J, Liu YP, Ren H, Liu J, Li GF, Du XH, Tang Y, Jing H, Ma YC, Huang Z, Chen B, Tang Y, Li N, Lu NN, Qi SN, Yang Y, Sun GY, Liu XF, Li YX. 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; 38:3604-3614. [PMID: 32780661 DOI: 10.1200/jco.20.01024] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE No randomized trials have compared hypofractionated radiotherapy (HFRT) with conventional fractionated radiotherapy (CFRT) after breast-conserving surgery in the Asian population. This study aimed to determine whether a 3.5-week schedule of HFRT is noninferior to a standard 6-week schedule of CFRT in China. PATIENTS AND METHODS Patients from 4 Chinese institutions who had undergone breast-conserving surgery and had T1-2N0-3 invasive breast cancers participated this study. Patients were randomly assigned (1:1) using a computer-generated central randomization schedule, without stratification, to receive whole-breast irradiation with or without nodal irradiation, followed by tumor-bed boost, either at a dose of 50 Gy in 25 fractions over 5 weeks with a boost of 10 Gy in five fractions over 1 week (CFRT) or 43.5 Gy in 15 fractions over 3 weeks with a boost of 8.7 Gy in three daily fractions (HFRT). The primary endpoint was 5-year local recurrence (LR), and a 5% margin of 5-year LR was used to establish noninferiority. RESULTS Between August 2010 and November 2015, 734 patients were assigned to the HFRT (n = 368) or CFRT (n = 366) group. At a median follow-up of 73.5 months (interquartile range, 60.5-91.4 months), the 5-year cumulative incidence of LR was 1.2% in the HFRT group and 2.0% in the CFRT group (hazard ratio, 0.62; 95% CI, 0.20 to 1.88; P = .017 for noninferiority). There were no significant differences in acute and late toxicities, except that the HFRT group had less grade 2-3 acute skin toxicity than the CFRT group (P = .019). CONCLUSION CFRT and HFRT with a tumor-bed boost may have similar low LR and toxicity.
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Affiliation(s)
- Shu-Lian Wang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hui Fang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chen Hu
- Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yong-Wen Song
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei-Hu Wang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Jin
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yue-Ping Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hua Ren
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Juan Liu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gao-Feng Li
- Department of Radiation Oncology, Beijing Hospital, Beijing, China
| | - Xiang-Hui Du
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yu Tang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Hao Jing
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yu-Chao Ma
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zhou Huang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Bo Chen
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuan Tang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ning Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ning-Ning Lu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shu-Nan Qi
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yong Yang
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Guang-Yi Sun
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin-Fan Liu
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ye-Xiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Yu E, Huang D, Leonard K, Dipetrillo T, Wazer D, Hepel J. Analysis of Outcomes Using Hypofractionated Tumor Bed Boost Combined With Hypofractionated Whole Breast Irradiation for Early-stage Breast Cancer. Clin Breast Cancer 2017. [DOI: 10.1016/j.clbc.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lee SW, Shin KH, Chie EK, Kim JH, Im SA, Han W, Noh DY, Lim HW, Kim TH, Lee KS, Lee ES, Sung SY, Kim K. Accelerated whole breast irradiation in early breast cancer patients with adverse prognostic features. Oncotarget 2016; 7:81888-81898. [PMID: 27588485 PMCID: PMC5348439 DOI: 10.18632/oncotarget.11702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/26/2016] [Indexed: 11/25/2022] Open
Abstract
Purpose Accelerated whole breast irradiation (AWBI) and conventional whole breast irradiation (CWBI) were compared to determine whether AWBI is as effective as CWBI in patients with early breast cancer and adverse prognostic features. Patients and methods We included 330 patients who underwent breast-conserving surgery (BCS) and post-operative radiation therapy (RT) using AWBI for pT1-2 and pN0-1a breast cancer from 2007 to 2010. These patients were matched with 330 patients who received CWBI according to stage, age (±3 years), and the year of BCS. AWBI of 39 Gy and CWBI of 50.4 Gy were given in 13 and 28 fractions, respectively. Results Median follow-up time was 81.9 months. There were no statistically significant differences between the AWBI and CWBI groups in terms of age, stage, tumor grade, or molecular subtype. More patients with Ki-67 index ≥ 14% were present in the AWBI group (AWBI 47.0% vs. CWBI 10.3%; P<0.01). The 5-year ipsilateral breast tumor relapse (IBTR) rates for the AWBI and CWBI groups were 0.8% and 1.8%, respectively (P=0.54). High tumor grade was a statistically significant risk factor for IBTR (5-year IBTR rate: 2.9%; P=0.01). Ki-67 ≥ 14% was marginally related to IBTR (5-year IBTR rate: 2.2%; P=0.07). There were no statistically significant differences in the hazard ratios between the AWBI and CWBI groups according to any of the risk factors. There were no acute grade 3 toxicities in the AWBI group. There were no late grade 3 toxicities in either group. Conclusions AWBI is comparable to CWBI in early breast cancer with adverse prognostic features.
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Affiliation(s)
- Sea-Won Lee
- Seoul National University, College of Medicine, Seoul, Korea.,Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Seoul National University, College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Seoul National University, College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Seoul National University, College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Seoul National University, College of Medicine, Seoul, Korea
| | - Wonshik Han
- Seoul National University, College of Medicine, Seoul, Korea
| | - Dong-Young Noh
- Seoul National University, College of Medicine, Seoul, Korea
| | - Hyeon Woo Lim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Tae Hyun Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Keun Seok Lee
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eun Sook Lee
- Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Soo Yoon Sung
- Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Ewha Womans University, School of Medicine, Seoul, Korea
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Kim KS, Shin KH, Choi N, Lee SW. Hypofractionated whole breast irradiation: new standard in early breast cancer after breast-conserving surgery. Radiat Oncol J 2016; 34:81-7. [PMID: 27306774 PMCID: PMC4938347 DOI: 10.3857/roj.2016.01697] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/14/2016] [Accepted: 03/16/2016] [Indexed: 01/13/2023] Open
Abstract
Hypofractionated whole breast irradiation (HF-WBI) has been proved effective and safe and even better for late or acute radiation toxicity for early breast cancer. Moreover, it improves patient convenience, quality of life and is expected to be advantageous in the medical care system by reducing overall cost. In this review, we examined key randomized trials of HF-WBI, focusing on adequate patient selection as suggested by the American Society of Therapeutic Radiology and Oncology (ASTRO) guideline and the radiobiologic aspects of HF-WBI in relation to its adoption into clinical settings. Further investigation to identify the current practice pattern or cost effectiveness is warranted under the national health insurance service system in Korea.
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Affiliation(s)
- Kyung Su Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Noorie Choi
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiation Oncology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Lee SW, Kim YJ, Shin KH, Kim K, Chie EK, Han W, Im SA, Jung SY, Lee KS, Lee ES. A Comparative Study of Daily 3-Gy Hypofractionated and 1.8-Gy Conventional Breast Irradiation in Early-Stage Breast Cancer. Medicine (Baltimore) 2016; 95:e3320. [PMID: 27175630 PMCID: PMC4902472 DOI: 10.1097/md.0000000000003320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We retrospectively compared accelerated hypofractionation (AHF) with conventional fractionation (CF) in the radiation therapy (RT) for early-stage breast cancer patients.Three hundred seventy-nine early-stage (pT1-2 and pN0-1a) breast cancer patients who received RT with AHF after breast-conserving surgery (BCS) were included. These patients were matched with 379 corresponding patients who received BCS and RT with CF at a different center with respect to the year BCS was performed, patient age (±3 years), and cancer stage. The AHF regimen consisted of 39 Gy in 13 fractions to the whole breast and a consecutive boost of 9 to 12 Gy in 3 to 4 fractions to the tumor bed. CF comprised whole-breast irradiation up to 50.4 Gy in 28 fractions and a boost of 9 to 14 Gy in 5 to 7 fractions to the tumor bed.The median follow-up period was 75 months (range, 3.8-110.8 months). There was no statistically significant difference between the AHF and CF groups in terms of age distribution, T and N stage, resection margin, and histologic grade. There were 5 ipsilateral breast tumor relapse (IBTR) cases in the AHF group compared with 7 cases in the CF group. Seven and eight locoregional relapse (LRR) cases were observed in the AHF and CF groups, respectively. The 7-year rates of IBTR-free survival, LRR-free survival, and disease-free survival were 98.9%, 98.4%, and 97.1% in the AHF group and 98.1%, 97.9%, and 96.0% in the CF group, respectively (P > 0.05). The incident rates of grade 3 edema, hyperpigmentation, or wet desquamation at the end of RT were higher in the CF group than in the AHF group (16.4% vs 0.2%, respectively; P < 0.01).AHF RT of 39 Gy to the whole breast plus a 9-Gy boost in 16 fractions showed excellent tumor control and tolerable skin toxicity, a finding that is comparable to CF RT in patients with early-stage breast cancer.
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Affiliation(s)
- Sea-Won Lee
- From the Seoul National University College of Medicine, Seoul (S-WL, KHS, KK, EKC, WH, S-AI); and Research Institute and Hospital, National Cancer Center, Goyang, Korea (Y-JK, S-YJ, KSL, ESL)
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Janssen S, Glanzmann C, Lang S, Verlaan S, Streller T, Wisler D, Linsenmeier C, Studer G. Hypofractionated radiotherapy for breast cancer acceleration of the START A treatment regime: intermediate tolerance and efficacy. Radiat Oncol 2014; 9:165. [PMID: 25059887 PMCID: PMC4112649 DOI: 10.1186/1748-717x-9-165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 07/12/2014] [Indexed: 11/29/2022] Open
Abstract
Purpose Prospective evaluation of accelerated hypofractionated radiotherapy (RT) in breast cancer patients treated with 41.6 Gy in 13 fractions plus boost delivered five times a week. Patients and methods Between 03/2009 and 10/2012 98 consecutive patients aged >55 years presenting with breast cancer (invasive cancer: n = 95, ductal carcinoma in situ (DCIS): n = 3) after breast conserving surgery were treated in our institution with the following schedule: 41.6 Gy in 13 fractions 4 times a week and 9 or 12 Gy boost in 3 or 4 fractions (on day 5 each week), cumulative dose: 50.6 Gy in 3.2 weeks or 53.6 Gy in 3.4 weeks, respectively depending on resection status. 56 patients had a T1 tumor, 39 a T2 tumor. N-status was as follows: N0: n = 71, N1: n = 25, N2/3: n = 2. 23 patients (24%) received chemotherapy before RT. A prospectively planned follow-up (FU) visit with objective and subjective assessment of treatment tolerance (questionnaires) was performed 0 and 8 weeks after RT completion, and one, two and four years later, respectively. Results Mean/median follow-up was 32/28 months (range: 12-56). After 2 years local control, loco-regional control and disease-free survival was 100%, 100%, and 98%, respectively. Overall survival was 96% at 2 years. Cosmetic outcome was very good with patients being satisfied or very satisfied in 99% (n = 86/87), 97% (n = 55/57) and 100% (n = 25/25) after one, two and four years after RT, respectively. No grade ≥ 2 pain was described in the 25 patients with a FU of at least 4 years. Fibrosis, telangiectasia and edema were found in 7-15%, 0-22% and 0-11% at one, two, and four years, respectively, and are comparable to other trials. Conclusion The applied hypofractionated RT regime with single doses of 3.2 Gy plus boost doses of 9-12 Gy in 3–4 fractions applied in 5 sessions a week was effective and well tolerated on intermediate term FU.
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Affiliation(s)
| | | | | | | | | | | | | | - Gabriela Studer
- Department of Radiation Oncology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
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