A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer

Abstract

Introduction: The aim of this analysis was a retrospective evaluation of the efficacy and toxicity of 2 hypofractionated irradiation schedules compared to conventional therapy in post-mastectomy patients. Methods: 3 irradiation schedules were analyzed: 48.30 Gy in 21 fractions (group A, n = 60), 42.56 Gy in 16 fractions (group B, n = 27) and 50 Gy in 25 fractions (group C, n = 30) of the front chest wall. All groups were also treated with a supraclavicular field, with 39.10 Gy in 17 fractions (group A), 37.24 Gy in 14 fractions (group B) or 45 Gy in 25 fractions (group C). Results: No local recurrences were noted in any group during 36 months of follow-up. Acute skin toxicity presented in all groups, with 58.3%, 70.4% and 60% of grade I; 35%, 25.9% and 40% of grade II; 6.7%, 3.7% and 0% of grade III being seen in groups A, B and C, respectively. Late skin toxicity was noted only as grade I in 16.7%, 25.9% and 26.7% of groups A, B and C, respectively. No significant difference was noted among all groups for either acute or late skin toxicity, or for radio-pneumonitis (chi2 test, p > 0.05). Conclusion: All schedules were equally effective with equivalent toxicity. A prospective randomized study is needed to confirm our results.

Conventional versus hypofractionated postmastectomy radiotherapy: a report on long-term outcomes and late toxicity

“…However, HF-PMRT had a significant higher number of radiation boost patients than CF-HFRT ( p < 0.001); the late skin toxicity is also increase corresponding with a high dose delivery. The incidence rate of severe skin toxicity (grade 2 or higher) was comparable to other studies [15, 18–20], except for the Egyptian study [14]. The Egyptian study published grade 2 or higher skin fibrosis of 17% with the conventional radiation group, 33% in the 45 Gy in 17 fractions group, and 37% in the 40 Gy in 15 fractions group [14].…”

“…At the 7 year follow-up, no statistically significant difference in local recurrence (3, 1, and 2 patients, respectively) and mortality (4, 2, and 3 patients respectively) was found between the groups. Researchers in Greece compared conventional radiotherapy (50 Gy in 25 fractions) and hypofractionated radiotherapy (48.3 Gy in 21 fractions and 42.56 Gy in 16 fractions) and demonstrated that no patients developed a locoregional relapse with any of the treatment regimens [15]. However, this study had a short-term follow-up interval with a median time of 36 months.…”

Comparing hypofractionated to conventional fractionated radiotherapy in postmastectomy breast cancer: a meta-analysis and systematic review

“…5. Acute Skin Toxicity: Twenty-three studies [12,[14][15][16][17][18][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] reported acute skin toxicity in 3456 patients, and results showed no significant difference between the two groups (OR = 0.94, 95% CI = 0.67~1.32, P = 0.72, Fig. 3a).…”

“…7. Late Skin Toxicity: Seven studies [12,14,17,18,26,30,31] reported late skin toxicity in 1363 patients, and results showed no significant difference between the two groups (OR = 0.98, 95% CI = 0.75~1.27, P = 0.88, Fig. 3c).…”

Possible benefits from post-mastectomy radiotherapy in node-negative breast cancer patients: a multicenter analysis in Korea (KROG 14-22)

“…Furthermore, the study regarding hypofractionated RT after mastectomy could be considered. Some investigators have suggested that hypofractionated RT is also an alternative option for PMRT [ 22 ], although it has not been thoroughly studied as in post-breast conserving surgery RT [ 23 – 25 ].…”