title: [Hypofractionated breast radiotherapy in 13 fractions, perfect tolerance or delayed early reaction? Prospective study of Curie Institute].
abstract: OBJECTIVE
  To assess the skin toxicity of this scheme and the time to its appearance.
  
  
  METHODS
  Eighty-one prospectively recorded patients (pts), treated in Radiotherapy Department for Breast Cancer (BC) with radiotherapy (RT) to the whole breast at the dose of 42.9Gy per 13 fractions (F) per 5 weeks have been studied. Skin reactions were monitored weekly using the National Cancer Institute-Common Toxicity Criteria scoring system, version 3. All risk factors as tobacco smoking, diabetes, obesity were also recorded.
  
  
  RESULTS
  All 81 pts, aged from 40 to 83 years (median: 70 years) received whole breast RT 42.9Gy per 13 F without lymph node irradiation after breast conserving surgery. There were no pts with concurrent chemo- and/or hormonal therapy. Seventeen patients (21%) have been treated using decubitus dorsal (DD) technique and 64 (79%) using the previously described isocentric decubitus lateral (IDL) technique. During the RT, only 34 pts (42%) experienced grade I skin reactions and 47 pts (58%) were without. At the last day of the breast irradiation, there were 66 (81%) grade I (N=59) and II (N=7) skin reactions and 15 pts (19%) without. The early skin tolerance of this scheme was considered to be excellent. But in the 2 weeks after the RT, 20 pts (25%) asked for new clinics with their radiation oncologist as a matter of urgency due to worsening of their skin condition. All of them have been seen by their physician and/or the nurse. Of them, nine presented grade I and 11 presented grade II skin reactions, with necessity of special skin care. The analysis of these results was realized and delayed clinics were organized for all pts treated with this scheme 10-14 days after the end of the radiation treatment.
  
  
  CONCLUSIONS
  The breast RT 42.9Gy/13 F have been previously described as an efficacious and well tolerated scheme. This prospective homogeneous group of patients showed that delayed early skin reactions could appear in some cases. Therefore complementary clinics are needed to detect and treat these reactions.
authors.affiliation: Radiation oncology, institut Curie, 26, rue d'Ulm, 75005 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Botti
authors.forename: Y M
authors.initials: YM
authors.lastname: Kirova
authors.forename: R
authors.initials: R
authors.lastname: Dendale
authors.forename: A
authors.initials: A
authors.lastname: Savignoni
authors.forename: I
authors.initials: I
authors.lastname: Fromantin
authors.forename: C
authors.initials: C
authors.lastname: Gautier
authors.forename: M A
authors.initials: MA
authors.lastname: Bollet
authors.forename: F
authors.initials: F
authors.lastname: Campana
authors.forename: A
authors.initials: A
authors.lastname: Fourquet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002278:Carcinoma in Situ / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012867:Skin / Q000528:radiation effects*