Once‐weekly hypofractionated radiotherapy for breast cancer: First results of a phase II clinical trial

Rebouças, Liêvin Matos; Campos, Conceicao Souza; D’Amico, Giovanna; Lustosa, Alysson Bastos; Fregnani, José Humberto Tavares Guerreiro

doi:10.1111/tbj.13372

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…Considering moderate–severe acute toxicity at the end of RT, both erythema, edema and epitheliolysis rate did not exceed 10%, in agreement with previous studies (Ortholan et al 2005 ; Rovea et al 2015 ; Bonzano et al 2019 ). This data represents a better result compared to other group findings (Dragun et al 2013 ; Sanz et al 2018 ; Reboucas et al 2019 ), although Dragun et al and Reboucas et al rated toxicity with a different scale (CTCAE version 3.0). Furthermore, in our report only one G3 erythema was recorded, confirming severe acute toxicity was negligible/minor.…”

Section: Discussionmentioning

confidence: 46%

Ultra-hypofractionated whole breast adjuvant radiotherapy in the real-world setting: single experience with 271 elderly/frail patients treated with 3D and IMRT technique

Zerella

Dicuonzo

Frassoni

et al. 2022

J Cancer Res Clin Oncol

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Purpose The purpose of the study was to evaluate the toxicity, local control, overall and disease-free survival of elderly breast cancer (BC) patients treated with adjuvant once-weekly ultra-hypofractionated radiotherapy (RT) either with intensity-modulated RT (IMRT) or 3D conformal RT (3DCRT). Methods From July 2011 to July 2018, BC patients receiving 5.7 Gy once a week for 5 weeks to the whole breast after breast-conserving surgery were considered for the study. Inclusion criteria were: T1–T3 invasive BC, no or limited axillary involvement, age ≥ 65 years or women with commuting difficulties or disabling diseases. Results A total of 271 patients were included in the study. Median age was 76 (46–86) years. Most of BC were T1 (77%), while the remaining were T2 (22.2%) and T3 (0.4%). Axillary status was negative in 68.3% of the patients. The only severe acute toxicity (G3) at the end of RT was erythema (0.4%), registered in the 3DCRT group; no G3 edema or epitheliolysis was recorded. With 18 months of median follow-up, severe early–late toxicity (G3) was reported in terms of fibrosis and breast retraction, both with an incidence of 1.4%, mostly in the 3DCRT group. Oncological outcomes at a median follow-up of 2.9 years reported 249/271 (91.9%) patients alive and free from any event and 5 (1.8%) isolated locoregional recurrences. At 3 years, disease-free survival and overall survival were 94.9% and 97.8%, respectively. Breast volume > 500 cm 3 was reported as predictive for moderate–severe (≥ G2) acute toxicity. Conclusions Weekly ultra-hypofractionated whole breast RT seems feasible and effective. Toxicity was mild, local control was acceptable, and overall survival was 97.8% at 3 years. Rates of severe toxicity were reduced with the IMRT technique. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03907-w.

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Section: Discussionmentioning

confidence: 46%

Ultra-hypofractionated whole breast adjuvant radiotherapy in the real-world setting: single experience with 271 elderly/frail patients treated with 3D and IMRT technique

Zerella

Dicuonzo

Frassoni

et al. 2022

J Cancer Res Clin Oncol

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“…It is documented that up to 95% of patients who undergo radiotherapy will develop moderate-to-severe skin reactions [19]. Randomized trials showed that 3-week schedule of 40 Gy had less acute and late skin toxicity events compared to the conventional 5-week schedule radiotherapy for breast cancer [20][21][22]. In FAST-Forward trial late normal tissue skin effect were worse for 27 Gy compared to 40 Gy at 5 years follow-up, but similar for 26 Gy in 5 fraction schedule [9].…”

Section: Discussionmentioning

confidence: 99%

Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic

et al. 2022

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Background and Objectives: Reducing time of treatment during COVID-19 outbreaks has been recommended by the leading Radiation Oncology societies. Still minimizing radiation induced tissue toxicity is one of the most important issues in breast cancer patients. The study aimed to investigate compliance, clinical and dosimetry normal tissue toxicity, and cosmetic results between moderated and ultra-fractionated regimes for breast cancer patients during COVID-19 pandemic. Materials and Methods: This pilot prospective randomized study included 60 patients with early breast cancer after preserving surgery, 27 patients advocated to ultra-hypofractionated whole-breast three dimensional (3D) conformal radiotherapy of 26 Gy in 5 fractions over 1 week and 33 patients with moderate fractionated breast 3D conformal radiotherapy patients between March 2020 and July 2020, during the COVID pandemic outbreak. The compliance to treatment, dosimetric parameters, acute and late skin toxicity, subcutaneous tissue toxicity, cosmetic results and clinical follow up for 18 months for the two regimes were analyzed and compared. Results: When two regimes were compared 5 fraction group had significantly lower prevalence of newly infected cases of SARS-CoV-2 and thus delayed/interrupted treatment (p = 0.05), comparable grade 1 CTCAE v5, acute skin toxicity (p = 0.18), Grade 1 Radiation Morbidity Scoring Scheme (RESS) subcutaneous tissue toxicity (p = 0.18), Grade 1 RESS late skin toxicity (p = 0.88) and cosmetic results (p = 0.46). Dosimetric results reveled that patients in 5 fraction group received significantly lower median ipsilateral lung doses (p < 0.01) in addition to left breast cancer patients that received significantly lower median heart dose (p < 0.01) and median left anterior descending artery (LAD) dose (p < 0.01). Conclusion: Ultra-hypofractionated radiotherapy for breast cancer is comparable to moderate hypofractionation regimen regarding grade 1 acute skin toxicity, grade 1 subcutaneous tissue toxicity, late skin toxicity and cosmetic results. Application of ultra-hypofractionated radiotherapy with significantly lower radiation doses for lung and heart could be crucial in reducing the risk of acute/late pulmonary and heart radiation-induced toxicity.

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“…Excellent or good cosmesis was 82.3%, and 17.7% was average or poor. Rebouças et al 22 presented the initial results of toxicities for a prospective phase II study. The prescribed dose was 30 Gy into five fractions of 6.0 Gy, one fraction weekly, without a supplementary dose at the tumor bed.…”

Section: Hyper-hypofractionation-retrospective and Prospective Studiesmentioning

confidence: 99%

Hypofractionated and hyper-hypofractionated radiation therapy in postoperative breast cancer treatment

Fang¹,

Marta

2020

Rev. Assoc. Med. Bras.

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SUMMARY INTRODUCTION: Radiation therapy is widely used as adjuvant treatment in breast cancer patients. In the last decades, several studies have been designed to evaluate the safety and efficacy of hypofractionated breast radiation therapy. More recently, even shorter regimens with doses above 4 Gy (hyper-hypofractionation) have also been proposed. This study aims to present a narrative review of the various hypofractionation protocols used to treat breast cancer patients with a focus on clinical application. RESULTS: Long-term results from several phase III randomized controlled trials demonstrated the safety and efficacy of hypofractionated breast radiation therapy using 15 or 16 fractions for early and locally advanced disease. The results of the initial clinical trials of hyper-hypofractionation are also encouraging and it is believed that these regimens may become routine in the indication of adjuvant radiation therapy treatment after the ongoing studies on this subject have matured. CONCLUSIONS: The idea that normal tissues could present high toxicity at doses above 2 Gy was opposed by clinical trials that demonstrated that moderate hypofractionation had similar results regarding oncological and cosmetic outcomes compared to conventional fractionation. Cosmetic and toxicity results from hyper-fractionation studies are in principle favorable. However, the long-term oncological results of studies that used hyper-hypofractionation for the treatment of breast cancer patients are still awaited.

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Once‐weekly hypofractionated radiotherapy for breast cancer: First results of a phase II clinical trial

Cited by 5 publications

References 13 publications

Ultra-hypofractionated whole breast adjuvant radiotherapy in the real-world setting: single experience with 271 elderly/frail patients treated with 3D and IMRT technique

Ultra-hypofractionated whole breast adjuvant radiotherapy in the real-world setting: single experience with 271 elderly/frail patients treated with 3D and IMRT technique

Ultra-Hypofractionated vs. Moderate Fractionated Whole Breast Three Dimensional Conformal Radiotherapy during the COVID-19 Pandemic

Hypofractionated and hyper-hypofractionated radiation therapy in postoperative breast cancer treatment

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