Hypofractionated Whole-Breast Radiotherapy and Concomitant Boost after Breast Conservation in Elderly Patients

Abstract

Aims To report the 5- and 10-year results of accelerated hypofractionated whole-breast radiotherapy (WBRT) with concomitant boost to the tumor bed in 83 consecutive patients with early breast cancer aged >70 years. Methods All patients were treated with breast conservation and hypofractionated WBRT. The prescription dose to the whole breast was 45 Gy (2.25 Gy/20 fractions) with an additional daily concomitant boost of 0.25 Gy to the surgical cavity (2.5 Gy/20 fractions up to 50 Gy). The maximum detected toxicity was scored according to the Common Terminology Criteria for Adverse Events, version 3.0. We considered as skin toxicity: erythema, edema, desquamation, ulceration, hemorrhage, necrosis, telangiectasia, fibrosis-induration, hyperpigmentation, retraction and atrophy. Cosmetic results were assessed as set by the Harvard criteria. Results With a median follow-up of 60 months (range 36-88), no local recurrence was observed. The maximum detected acute skin toxicity was G0 in 57% of patients, G1 in 40% and G2 in 3%. Late skin and subcutaneous toxicity was generally mild with no ≥G3 events. The cosmetic results were excellent in 69% of patients, good in 22%, fair in 5%, and poor in 4%. Conclusions The present results support the use of hypofractionation employing a concomitant boost to the lumpectomy cavity in women aged >70 years. This is a convenient treatment option for both this type of population and health-care providers.

Hypofractionation with concomitant boost using intensity-modulated radiation therapy in early-stage breast cancer in Mexico

“…[11][12][13]22 In terms of acute toxicity, 47% presented with grade 1 radiodermatitis, and 53% did not exhibit any toxicity. [25][26][27][28][29][30][31][32] Chronic toxicity was evaluated after 6 months, and 6 patients developed grade 1 toxicity (telangiectasias and fibrosis). Good cosmesis was present in 82%, which is very similar to that reported by Formenti et al 13,19,20 as well as the results from studies that have involved HF and concomitant boost.…”

“…[25][26][27][28][29][30] Regarding patients over 70 years of age who have been treated with this schedule, the evidence is scarce, but the results have proven this approach to be an option for this population group. 20,[31][32][33][34][35] The 2018 management guides of the National Comprehensive Cancer Network (NCCN) indicate that boost to the tumour bed is indicated for those who are <50 years of age and have high-grade or focally positive margins. The boost to positive margins requires an increase of the dose to the tumour bed and may increase fibrosis.…”

The long-term outcome of adjuvant hypofractionated radiotherapy and conventional fractionated radiotherapy after breast-conserving surgery for early breast cancer: a prospective analysis of 107 cases

“…In addition, Doré et al (27) and Cante et al (25) revealed that whole-breast HF after breast-conserving surgery is a safe and efficient approach for elderly patients.…”

Cosmetic outcome of hypofractionated whole-breast irradiation with concomitant boost in breast cancer

“…DISCUSSIONCosmetic results scored in both arms after 12 month were excellent/good in 83.4% of patients and fair/poor in 16.7%, whereas superiorly, Cante et al reported cosmetic results were excellent in 69% of patients, good in 22%, fair in 5% and poor in 4%(21). Cante et al, as well in 2017, reported results of excellent/good in 87.8% of patients and fair/poor in 12.2%…”

“…The concomitant delivery of the TB boost along with WBRT further reduces OTT, with an eventual ulterior gain (7,14). The results of retrospective studies of hypofractionated radiotherapy in early breast cancer suggest satisfactory outcomes in terms of tumour control and late adverse effects (15)(16)(17), this applies when modest increases in fraction size are combined with consequent and appropriate downward adjustments of the total dose (18)(19)(20)(21).…”