Hypofractionated versus conventionally fractionated radiotherapy for ductal carcinoma in situ (DCIS) of the breast

Abstract

Introduction Hypofractionated radiotherapy (RT) in the setting of early invasive breast cancer has been shown to have similar local control rates and cosmetic outcomes as conventionally fractionated RT. This study compares ipsilateral recurrence rates between hypofractionated and conventional RT, with and without a boost. The effect of hypofractionated RT and chest wall separation (CWS) on cosmetic outcome was also assessed. Methods All patients with ductal carcinoma in situ (DCIS) treated between 1998 and 2012 across two sites of a single cancer institution were retrospectively studied. Patients were analysed according to those receiving conventional RT (≤2 Gy per fraction) and those receiving hypofractionated RT (>2 Gy per fraction), as well as the presence or absence of a tumour bed boost. Data were collected through electronic medical records and local cancer registry. Cosmetic outcome was scored by physicians on a four‐point scale during clinical follow‐up appointments. Results One hundred and ninety‐seven patients were treated for DCIS during the study period. One hundred and forty‐one were treated with conventional RT, and 56 with hypofractionated RT. After a median follow up of 4.4 years, there were 12 ipsilateral recurrences, of which seven were invasive disease and five DCIS. Ten recurrences occurred in patients who received conventional RT (7.1% recurrence rate) and two in those who received hypofractionated RT (3.6% recurrence rate) (P = 0.48). Cosmetic outcomes were not significantly different between conventional and hypofractionated RT (P = 0.06). Conclusions Hypofractionation represents a suitable alternative for treating DCIS in the absence of randomised data.

Toxicity and cosmetic outcome in hypofractionated radiation therapy for ductal carcinoma in situ after breast-conserving surgery: a preliminary report

“…Our study found that 93-100% of patients had grade 0 to 1 acute and late toxicities. These results are in line with the skin toxicity finding reported in other retrospective studies (6)(7)(8)12,13) .…”

“…In terms of cosmesis, 93% of the patients who reached the 6-month follow-up visit had excellent to good cosmetic outcomes, which is consistent with a previous report of 92.9% (8) . The two patients (6.9%) who noted only a fair cosmetic result had a breast volume of more than 1,000 cc, although this reflected 33% of all the patients with a large breast volume (> 1,000 cc).…”

“…Furthermore, there were no significant changes in cosmetic outcomes between conventional and HFx treatment. (p= 0.06) (8) .…”

Efficacy and safety analysis of hypofractionated and conventional fractionated radiotherapy in postoperative breast cancer patients

“…This paper involved a comprehensive analysis of 35 studies [ 5 , 8 , 14 , 16 , 24 – 54 ] comprising a total of 18,246 patients who had been diagnosed with breast cancer. The sample consisted of 13 randomized controlled trials with a Jadad score exceeding 4 and 22 retrospective studies with a Newcastle–Ottawa Scale score of 6 or higher.…”