Acute toxicity and health-related quality of life after accelerated whole breast irradiation in 5 fractions with simultaneous integrated boost

Abstract

Introduction: Acceleration of radiotherapy in 5 fractions for breast cancer can reduce the burden of treatment. We report on acute toxicity after whole-breast irradiation with a simultaneous integrated boost in 5 fractions over 10e12 days. Material and methods: Acute toxicity and health-related quality of life (HRQoL) of 200 patients, randomized between a 15-or 5-fractions schedule, were collected, using the CTCAE toxicity scoring system, the Multidimensional Fatigue Inventory, EORTC QLQ-C30 and BR23 and the BREAST-Q questionnaire. The prescribed dose to the breast was either 15*2.67 Gy (40.05 Gy) or 5*5.7 Gy (28.5 Gy). 90% of patients received a SIB to a cumulative dose of 46.8 Gy (15*3.12 Gy) or 31 Gy (5*6.2 Gy). Results: Physician-assessed toxicity was lower for the 5-fractions group. A significant difference was observed for breast pain (p ¼ 0.002), fatigue (p < 0.0001), breast edema (p ¼ 0.001) and dermatitis (p ¼ 0.003). Patients treated in 5 fractions reported better mean HRQoL scores for breast symptoms (p ¼ 0.001) and physical well-being (p ¼ 0.001). A clinically important deterioration in HRQoL of 10 points or more was also less frequently observed in the latter group for physical functioning (p ¼ 0.0005), social functioning (p ¼ 0.0007), fatigue (p ¼ 0.003), breast symptoms (p ¼ 0.0002) and physical wellbeing (p ¼ 0.002). Conclusion:In this single institute study, acute toxicity of accelerated breast radiotherapy in 5 fractions over 10e12 days seems to compare favourably to hypofractionated breast radiotherapy in 15 fractions. Less breast edema, dermatitis, desquamation, breast pain and fatigue are seen. Social and physical functioning are also less disturbed and patients have a better future perspective.

Acute adverse events of ultra-hypofractionated whole-breast irradiation after breast-conserving surgery for early breast cancer in Japan: an interim analysis of the multi-institutional phase II UPBEAT study

“…The FAST-Forward trial adopted 10 or 16 Gy in 2-Gy fractions[8, 9]; however, we assumed that a shorter schedule would be desirable. It has been reported that ultra-HF-WBI using simultaneous integrated boost (SIB) is tolerable in terms of acute toxicities [17,18]. SIB might represent a better alternative, as it does not prolong the treatment period.…”

Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial

“…Compared to other studies, a relatively short OTT in both treatment arms was achieved by using a RT schedule in 5 fractions, delivered over 10–12 days. The RT schedule in 5 fractions is still experimental, although the results from the YO-HAI5, FAST and FAST-FORWARD trials are promising [ [10] , [11] , [12] ]. The UK FAST trial (5 fractions over 5 weeks) and FAST-FORWARD trial (5 fractions over 5 days) showed, compared to 25 or 15 fractions, no significant differences in relapse rates or survival as expected based on radiobiology, nor an increase in normal tissue toxicity after 10 years and 5 years, respectively [ 10 , 11 ].…”

“…For the 5-fractions schedule over 10–12 days no long-term randomized evidence exists. An interim analysis of the YO-HAI5 study, randomizing between 5 fractions over 10–12 days and 15 fractions over 3 weeks, showed less acute toxicity [ 12 ] and better short-term HRQoL for the 5 fractions schedule [ 14 ]. A matched-case analysis with patients treated in 15 fractions, showed less 2-year toxicity except for fibrosis outside of the tumour bed [ 30 ].…”

“…Patients were followed until 6 months after surgery (intervention arm) or RT (control arm) to determine any treatment complications or any additional surgeries including mastectomy. Acute RT toxicity was determined two to four weeks after the last fraction, using standardized questionnaires previously published [ 12 ].…”

“…Accelerated RT in 5 fractions did not increase the risk of local relapse at 10 and 5-years in the recently published FAST and FAST-FORWARD trials, respectively [ 10 , 11 ]. Moreover, acceleration in 5 fractions resulted in lower acute toxicity with similar late toxicity, better health related quality of life (HRQoL), and OTT [ 10 , [12] , [13] , [14] ]. The European Society of Medical Oncology (ESMO) guidelines recommend a radiotherapy boost to the tumorbed in patients with a high risk of recurrence [ 1 ], as is often the case in patients receiving NACT.…”