Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3-week regimen delivered in the UK FAST-Forward Trial

Brunt, Adrian Murray; Wheatley, Duncan; Yarnold, John; Somaiah, Navita; Kelly, Stephen; Harnett, Adrian; Coles, Charlotte E.; Goodman, Andrew; Bahl, Amit; Churn, Mark; Zotova, R.; Sydenham, M.; Griffin, Clare; Morden, James P.; Bliss, Judith

doi:10.1016/j.radonc.2016.02.027

Cited by 184 publications

(140 citation statements)

References 3 publications

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“…Results from FAST‐Forward UK phase III study are also awaited as the regimens of 5 or 15 days were compared. The first outcomes showed mild acute skin reactions with 1‐week schedules …”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis on safety and effectiveness of hypofractioned post‐mastectomy radiotherapy

2019

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The data supporting hypofractionated post‐mastectomy radiotherapy is limited. The purpose of this study is to present the experience from Tarnów of hypofractionated PMRT over 20 fractions with respect to toxicity and effectiveness. We delivered post‐mastectomy radiotherapy at the dose of 45 Gy in 20 fractions to the chest wall and the draining regional lymph nodes. The primary outcome of interest was to ensure that the rate of grade 3 or greater toxicity from the hypofractionation, at any time point, was non‐inferior to standard post‐mastectomy radiotherapy. We conducted a retrospective analysis of 211 women with stages I‐IV breast cancer. After a median follow‐up of 30 months, there were four reported grade 3 toxicities, with grade 3 lymphedema being the most frequent (1.5%). There were 134 reported grade 2 toxicities, with grade 2 fatigue being the most frequent (18%). There were six instances of isolated locoregional (6 of 211; 2.8%). Three‐year estimated local recurrence‐free survival was 96.4% (95% CI 0.921‐0.984). The 3‐year estimated distant recurrence‐free survival was 77.8% (95% CI 0.699‐0.838). To our knowledge, the results presented here are the largest single institution experience of hypofractionated post‐mastectomy radiotherapy published in the literature to date. Our fractionation scheme, 45 Gy in 20 fractions, seems to be safe and effective with low toxicity.

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“…Results from FAST‐Forward UK phase III study are also awaited as the regimens of 5 or 15 days were compared. The first outcomes showed mild acute skin reactions with 1‐week schedules …”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis on safety and effectiveness of hypofractioned post‐mastectomy radiotherapy

2019

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“…Establishing the toxicities patterns and aesthetics changes through clinical trials is a fundamental step for the possible future use of adjuvant whole breast irradiation in 5 fractions, either once a week or in consecutive days, as in the FAST‐Forward protocol …”

Section: Discussionmentioning

confidence: 99%

Once‐weekly hypofractionated radiotherapy for breast cancer: First results of a phase II clinical trial

et al. 2019

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Hypofractionated radiotherapy (HF) in 15 or 16 daily fractions is well established as an alternative in early breast cancer after breast‐conserving surgery. Evidences for a whole‐breast treatment even shorter, in 5‐10 fractions, are still scarce. Women 50 years or older, with early breast tumor (pT1‐2pN0), after breast‐conserving surgery were eligible to enter in this phase II trial and received whole breast once‐weekly hypofractionated radiotherapy (wHF‐RT) to a total dose of 30 Gy, in 5 fractions of 6 Gy. During treatment and in post‐treatment follow‐up the toxicity was assessed and graduated according to the “Common Terminology Criteria for Adverse Events” (CTCAE), v3.0. Breast pictures for esthetic comparison were taken in 5 timepoints and 2 breast surgeons independently graduated the cosmetics changes. The trial was registered with ClinicalTrials.gov, number NCT01965483. From October 2013 to November 2015, 44 patients were enrolled in the trial and treated according to the protocol of wHF‐RT. The median age was 70.5 years (51‐88 years), and the median follow‐up was 22 months (9‐33 months). Skin erythema was the most common acute adverse event. At the end of radiation, 30 patients (68.2%) had any grade of radiation dermatitis. Concerning cosmetic appearance, there was no significant difference between pretreatment and 1 year assessments. The 2‐year overall survival and disease‐free survival were, respectively 96.8% and 97.7%. There was only one distant recurrence and no local or regional recurrence. Once‐weekly hypofractionated radiotherapy is a feasible and well tolerated alternative for early breast cancer adjuvant management with acceptable acute toxicity and esthetic outcomes.

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“…Fast‐Forward is a step further and is a phase 3 trial comparing 1‐week course with current UK 3‐week regimen. Early skin toxicity (grade >3 as assessed with the RT Oncology Group [RTOG], and the Common Terminology Criteria for Adverse Events [CTCAE] criteria) safety substudies revealed a maximum of up to 9.8% incidence in 1‐week course vs up to 13.6% in the 3‐week course . Long‐term outcomes are awaited with interest and potentially practice‐changing.…”

Section: Modifications Of Dose and Delivery Of Rtmentioning

confidence: 99%

Oncoplastic breast surgery and radiotherapy-Adverse aesthetic outcomes, proposed classification of aesthetic components, and causality attribution

Agrawal

2019

Breast J

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The aim of this paper is to discuss and understand the interplay of surgical and radiotherapy (RT) techniques that potentially affect the aesthetic outcomes following breast conservation treatment. It reviews the reported cosmetic outcomes within the practice‐changing RT trials incorporating varied fractionation regimes as well as sequence (before, during, or after surgery) over the past two decades. The paper importantly highlights an overall improvement in breast surgical techniques particularly oncoplastic breast conservation techniques due to dedicated and streamlined training of late. Hence, erstwhile complications or sequel of breast surgery and associated post‐RT aesthetic concerns may not be of the same variety or magnitude that were noted in the past. Paper thus concludes by highlighting the paradigm shift in the breast surgical practice that will have a bearing on the accuracy of RT outcomes assessed (within or out with clinical trials) with implications as a potential research and outcomes assessment gap.

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Acute skin toxicity associated with a 1-week schedule of whole breast radiotherapy compared with a standard 3-week regimen delivered in the UK FAST-Forward Trial

Cited by 184 publications

References 3 publications

A retrospective analysis on safety and effectiveness of hypofractioned post‐mastectomy radiotherapy

A retrospective analysis on safety and effectiveness of hypofractioned post‐mastectomy radiotherapy

Once‐weekly hypofractionated radiotherapy for breast cancer: First results of a phase II clinical trial

Oncoplastic breast surgery and radiotherapy-Adverse aesthetic outcomes, proposed classification of aesthetic components, and causality attribution

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