Hypofractionated radiation therapy for early breast cancer

Hickey, Brigid E; James, Melissa; Lehman, Margot; Hider, Phil; Jeffery, Mark; Francis, Daniel; See, Adrienne M

doi:10.1002/14651858.cd003860.pub4

Cited by 50 publications

(56 citation statements)

References 96 publications

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“…At the time of conception of the IMRT-MC2-trial, normofractionated radiotherapy was the standard of care after breast-conserving surgery for breast cancer. During the conduct of the trial, hypofractionated radiotherapy was shown to be equally effective in terms of tumor control with a slightly lower risk of acute and chronic cutaneous and subcutaneous side effects [ 35 ], a reduction in treatment time and better health economics [ 36 ]. However, for several subgroups, normofractionated radiotherapy is still regarded as the standard of care, especially patients who are planned to receive regional nodal irradiation.…”

Section: Discussionmentioning

confidence: 99%

Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer

et al. 2020

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Background Intensity-modulated radiotherapy (IMRT) improves dose homogeneity and late toxicity compared to simple tangential techniques in adjuvant whole-breast radiotherapy for patients with breast cancer. Simultaneous-integrated boost (SIB) radiotherapy shortens the overall treatment time and improves dose homogeneity. However, prospective randomized trials regarding IMRT with SIB for adjuvant radiotherapy in breast cancer are lacking. Methods The IMRT-MC2 (MINT) trial is a phase III prospective randomized controlled trial comparing IMRT with SIB (Arm A: whole breast 28 × 1.8 Gy, Boost 28 × 2.3 Gy) to 3D-conformal radiotherapy with a sequential boost (Arm B: whole breast 28 × 1.8 Gy, boost 8 × 2 Gy) in patients with breast cancer after BCS. Indication for boost radiotherapy was defined as age < 70 years or age > 70 years with presence of additional risk factors. This is a retrospective analysis of acute toxicity at one of two trial sites. Results Five hundred two patients were randomized, of which 446 patients were eligible for this analysis. There was no statistically significant difference in terms of any grade radiation dermatitis between the two treatment arms at the end of treatment (p = 0.26). However, radiation dermatitis grade 2/3 (29.1% vs. 20.1 and 3.5% vs. 2.3%) occurred significantly more often in Arm A (p = 0.02). Breast/chest wall pain at the first follow-up visit was significantly more common in patients treated on Arm B (p = 0.02). Conclusions Treatment on both arms was well tolerated, however there were some differences regarding radiodermatitis and breast pain. Further analyses are ongoing. Trial registration clinicaltrials.gov, NCT01322854, registered 24th March 2011.

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Section: Discussionmentioning

confidence: 99%

Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer

et al. 2020

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“…Recent studies demonstrate that accelerated partial breast irradiation (APBI) provides, in shorter time, similar rates of local control and similar breast cancer-specific and overall survival outcomes as treatment with whole breast radiation therapy (WBRT) in early-stage breast cancer patients[5–10]. However, a number of systematic reviews reported a lack of evidence about short-term RT side effects and their impact on changes in quality of life (QOL) [11–14]. One review of randomized clinical trials comparing PBI/APBI and conventional or hypo-fractionated WBRT found that no studies reported on the relative effects of PBI/APBI and WBRT on quality of life [15].…”

Section: Introductionmentioning

confidence: 99%

Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

Pérez

Schootman

Hall

et al. 2017

Breast Cancer Res Treat

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Purpose Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type. Methods We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤ 3.0 cm and lymph-node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 “not at all” to 5 “all the time”) and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors. Results Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up. Conclusions Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.

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“…Отдельные крупные рандомизированные исследования показывают сопоставимые результаты относительно локального контроля и поздних лучевых повреждений, при достоверном снижении острой лучевой токсичности [10]. Но существуют работы, показавшие преимущество использования методики гипоф-ракционирования в отношении поздних лучевых повреждений и качества жизни [20,21].…”

Section: результатыunclassified

“…При подробном изучении методик гипофракционирования в сравнении с традиционным режимом исследователями были показаны сопоставимые результаты общей и безрецидивной выживаемости [6][7][8]. Также режим гипофракционирования не уступает конвенциональному режиму облучения по безопасности, качеству жизни и косметическим результатам при различных объёмах хирургического лечения, а, по данным некоторых исследований, является методом выбора [9][10]…”

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Efficacy of Hypofractionated Adjuvant Radiation Therapy in Patients With Operable Breast Cancer

et al. 2018

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The purpose of the studywas to evaluate the efficacy and safety of hypofractionated postoperative radiation therapy (2.7 Gy per fraction in 15 fractions to a total dose of 40.5 Gy) in comparison with the standard fractionation regimen.Material and methods.The study included 321 patients diagnosed with stage I–IIIA breast cancer treated in the A. Tsyb Medical Radiological Research Center from 2013 to 2017. The patients were divided into two groups. Group I patients received hypofractionated postoperative radiotherapy at a total dose of 40.5 Gy in 15 fractions with Gy 2.7 Gy/fraction (n=223). Group II patients received conventional radiotherapy at a total dose of 50 Gy in 25 fractions with 2 Gy/fraction (n=98). Both groups were comparable in terms of the stage of the disease and molecular subtype of the tumor. The statistical analysis of the main characteristics of the studied regimens was carried out.Results.The analysis revealed no significant differences in the overall survival (OS) and disease-free survival (DFS) between two groups. The frequency of acute radiation-induced complications (grade 1 and 2) in Groups I and II were 79 % and 84 %, respectively. Late radiation-induced side effects were observed less frequently in patients treated with hypofractionated postoperative radiotherapy than in the control group patients (23 % versus 43 %, p<0.01). Severe post-radiation damage to normal tissues was not found. The extent of surgery did not affect the long-term treatment outcomes.Conclusion.Comparison of hypofractionated radiotherapy with conventional radiotherapy in breast cancer patients demonstrated the superiority of hypofractionated radiotherapy regimen in terms of late toxicity and economic profitability. Further studies of accelerated fractionated postoperative radiotherapy are required to improve the treatment outcomes in breast cancer patients.

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Hypofractionated radiation therapy for early breast cancer

Cited by 50 publications

References 96 publications

Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer

Acute toxicity of normofractionated intensity modulated radiotherapy with simultaneous integrated boost compared to three-dimensional conformal radiotherapy with sequential boost in the adjuvant treatment of breast cancer

Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

Efficacy of Hypofractionated Adjuvant Radiation Therapy in Patients With Operable Breast Cancer

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