Long‐term patient‐rated cosmetic and satisfactory outcomes of early breast cancer treated with conventional versus hypofractionated breast irradiation with simultaneous integrated boost technique

Abstract

To compare patient‐rated cosmetic and satisfactory outcomes between conventional fractionation with simultaneously integrated boost (C‐SIB) vs hypofractionation with SIB (H‐SIB) in early breast cancer. Patients with stage I and II breast cancer who received breast‐conserving surgery followed by radiation with SIB to tumor bed and completed questionnaire were included in this study. Radiotherapy was as follows: C‐SIB arm = 50 Gy and 65 Gy in 25 fractions and H‐SIB arm = 43.2 Gy and 52.8 Gy in 16 fractions to the whole breast and tumor bed, respectively. Single cross‐sectional assessment of the breast cosmesis was done by patients and radiation oncologist at a follow‐up visit. Breast cosmetic and satisfaction scores were collected using a four‐point Harvard/NSABP/RTOG cosmesis criteria scale and a four‐point Likert‐type scale, respectively. Of a total of 114 patients (C‐SIB = 57) and (H‐SIB = 57) arms, a median time from radiotherapy completion to questionnaire response was 7.2 years. Patient‐rated cosmetic outcome in C‐SIB vs H‐SIB was “excellent” in 40.3% vs 45.6%, “good” in 33.3% vs 42.1%, “fair” in 21.1% vs 10.5%, and “poor” in 5.3% vs 1.8% (P = .288). Corresponding satisfaction was “very satisfied” in 52.6% vs 57.9%, “satisfied” in 40.4% vs 35.1%, “neutral” in 7.0% vs 5.2%, and “unsatisfied” in 0% vs 1.8% (P = .683). Stage I and older age at radiotherapy were predictors for favorable (good or excellent) cosmesis and satisfaction, respectively. In early‐stage breast cancer, H‐SIB provided a trend for better cosmesis than C‐SIB while maintaining satisfaction. The reduction in treatment duration and cost as well as favorable cosmesis outcomes encourages the use of H‐SIB.

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

“…The second study by Lertbutsayanukul et al [31] analyzed 114 patients treated with NF-SIB (50/65 Gy in 25 fractions) or HF-SIB (43.2 Gy and 52.8 Gy in 16 fractions), both of which were applied with 3D-CRT. Their findings concur with Fiorentino et al and demonstrate reduced acute toxicity with HF-SIB.…”

Adjuvant hypofractionated radiotherapy with simultaneous integrated boost after breast-conserving surgery: A systematic literature review

“…The characteristics of the studies are reported in Table 1 . The articles were published from 2012 to 2021 [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . Two trials were randomized and controlled [ 17 , 18 ].…”

“… [15] 2017 0 0 Feasibility 10 24 47.9 20 2.025 2.4 VMAT 6 Lertbutsayanukul et al. [14] 2020 0 0 Patient-rated cosmetic 114 86.4 50.8 16 2.7 3.3 3DRT 6 Krug et al. [13] 2021 0 0 Acute skin toxicity 149 NA 61 16 2.5 3 59% 3DRT and 41% IMRT 6 Van Hulle et al.…”

“… [15] 0 0 20 80 60 40 0 20 80 70 30 20 80 Lertbutsayanukul et al. [14] NA NA NA NA NA NA NA NA NA NA NA NA NA Krug et al. [13] 32 48 19 95 5 NA NA NA 87 10 16 84 Van Hulle et al.…”

Hypofractionated Radiotherapy With Simultaneous-integrated Boost After Breast-conserving Surgery Compared to Standard Boost-applications Using Helical Tomotherapy With TomoEdge

“…This study found a positive tendency toward H-SIB. No objective data on toxicity rates were collected (42).…”