Seven fractions to deliver partial breast irradiation: the toxicity is Low

Abstract

PurposeTo assess toxicity and clinical outcome, in breast cancer patients treated with external beam partial breast irradiation (PBI) consisting of 35 Gy in 7 daily fractions (5 Gy/fraction).Materials and MethodsPatients affected by early-stage breast cancer were enrolled in this phase II trial. Patients had to be 60 years old or over and treated with breast conservative surgery for early stage invasive carcinoma.ResultsSeventy-three patients were analyzed. Median follow-up was 40 months. The proposed schedule was well tolerated. No Grade 3 toxicity was documented. Late toxicity was assessable for all the treated patients. Two patients (2.7%) developed Grade 2 pain 6 months after PBI. Four patients (5%) developed asymptomatic fat necrosis. Grade 2 fibrosis was observed in 5 patients (6.7%). No correlation was found between early and late toxicity and the type of adjuvant systemic therapy (no therapy vs. hormonal therapy vs. chemotherapy). No statistical correlation between dosimetric parameters and toxicity was found. Patients who developed Grade 2 radiation fibrosis had not higher radiation volumes to the untreated normal breast than those without fibrosis. Cosmesis was judged good/excellent in the majority of the cases (93%). One patient relapsed locally, and one developed distant metastases, corresponding to a 5-year local control and distant metastases-free survival of 98% and 96.7%, respectively.Conclusions35 Gy in 7 daily fractions is an effective and well-tolerated regimen to deliver PBI.

Ten daily fractions for partial breast irradiation. Long-term results of a prospective phase II trial

“…Grade III edema, subcutaneous toxicity, and moderate/severe contour defect were reported in 1 (3%), 4 (10%), and 5 (13%) patients, respectively. In a recent publication our group reported results of a shorter fractionation scheme, 35 Gy delivered in 7 daily fractions (5 Gy/fraction). With a median follow‐up of 40 months, the 5‐year local control was 98% with a low incidence of toxicity.…”

Hypofractionated radiotherapy for elderly breast cancer patients: from early stages disease to local palliation for unresectable disease

“…This study had accrued patients up to 75 years of age, and reports feasibility and acceptable toxicity of shorter course radiation ( 11 ). Long term results of phase 2 studies had published experiences with 40 Gy in 10 fractions as well as 35 Gy in 7 fractions demonstrating similar toxicity and local control ( 12 , 13 ). The grade 2 fibrosis rate was 5.9% versus 6.7%.…”

Delivery of Adjuvant Radiation in 5 Days or Less After Lumpectomy for Breast Cancer: A Systematic Review

“…31 Alternative 3D-CRT dose/fractionation regimens have also been evaluated in prospective studies with limited numbers of patients and short follow-up. [32][33][34][35][36] A common question with regards to technique and fractionation is daily versus twice daily treatments with EBRT APBI. A small RCT evaluated once versus twice daily APBI regimens (38.5 Gy/10 fractions) and found improved outcomes with once daily with respect to late skin toxicity, subcutaneous fibrosis, and adverse cosmesis when using 3D-CRT.…”