title: Five-year results of a prospective case series of accelerated hypofractionated whole breast radiation with concomitant boost to the surgical bed after conserving surgery for early breast cancer.
abstract: Accelerated hypofractionation (HF) using larger dose per fraction, delivered in fewer fractions over a shorter overall treatment time, is presently a consistent possibility for adjuvant whole breast radiation (WBRT) after breast-conserving surgery for early breast cancer (EBC). Between 2005 and 2008, we submitted 375 consecutive patients to accelerated hypofractionated WBRT after breast-conserving surgery for EBC. The basic course of radiation consisted of 45 Gy in 20 fractions over 4 weeks to the whole breast (2.25 Gy daily) with an additional daily concomitant boost of 0.25 Gy up to 50 Gy to the surgical bed. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) and local control (LC) were assessed. Late toxicity was scored according to the CTCAE v3.0; acute toxicity using the RTOG/EORTC toxicity scale. Cosmesis was assessed comparing treated and untreated breast. Quality of life (QoL) was determined using EORTC QLQ-C30/QLQ-BR23 questionnaires. With a median follow-up of 60 months (range 42-88), 5 years OS, CSS, DFS and LC were 97.6, 99.4, 96.6 and 100 %, respectively. Late skin and subcutaneous toxicity was generally mild, with few events > grade 2 observed. Cosmetic results were excellent in 75.7 % of patients, good in 20 % and fair in 4.3 %. QoL, assessed both through QLQ-C30/QLQ-BR23, was generally favorable, within the functioning and symptoms domains. Our study is another proof of principle that HF WBRT with a concurrent boost dose to the surgical cavity represents a safe and effective postoperative treatment modality with excellent local control and survival, consistent cosmetic results and mild toxicity.
authors: Radiotherapy Department, Ivrea Community Hospital, ASL TO4, Ivrea, Italy.
authors: Domenico
authors: D
authors: Cante
authors: Pierfrancesco
authors: P
authors: Franco
authors: Piera
authors: P
authors: Sciacero
authors: Giuseppe
authors: G
authors: Girelli
authors: Anna Maria
authors: AM
authors: Marra
authors: Massimo
authors: M
authors: Pasquino
authors: Giuliana
authors: G
authors: Russo
authors: Valeria Casanova
authors: VC
authors: Borca
authors: Guido
authors: G
authors: Mondini
authors: Ovidio
authors: O
authors: Paino
authors: Roberto
authors: R
authors: Barmasse
authors: Santi
authors: S
authors: Tofani
authors: Gianmauro
authors: G
authors: Numico
authors: Maria Rosa
authors: MR
authors: La Porta
authors: Umberto
authors: U
authors: Ricardi
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D055088:Early Detection of Cancer / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000401:mortality / Q000639:trends*; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome