title: Hypofractionated radiation treatment following mastectomy in early breast cancer: the Christchurch experience.
abstract: BACKGROUND
  Although hypofractionated radiotherapy (HFRT) has become an accepted option for whole-breast irradiation after breast-conserving surgery, there is limited evidence to support HFRT to the chest wall following mastectomy. We retrospectively analysed post-mastectomy patients treated with HFRT in Christchurch to determine whether HFRT yields acceptable efficacy and toxicity.
  
  
  METHODS
  The Christchurch oncology database was used to identify breast cancer patients treated with adjuvant HFRT to the chest wall following a mastectomy between 2003 and 2008. Eligible post-mastectomy patients were treated with 40 Gy in 16 daily fractions. Treatment outcomes assessed included local recurrence-free survival, breast cancer survival, overall survival and acute toxicities.
  
  
  RESULTS
  One hundred thirty-three patients were identified. The median follow-up period was 5.03 years. Three patients had a local recurrence as a first event, resulting in 5-year local recurrence-free survival of 97.6%. Five-year overall survival and 5-year breast cancer survival were 74.7% and 77.7%, respectively. The prospectively assessed acute toxicities were mostly grade 1. In particular, the incidence of grade 2 skin toxicity was 10.7%, and no patients experienced grade 3 skin toxicity.
  
  
  CONCLUSIONS
  The high local control rate with HFRT, combined with acceptable toxicity and the practical benefits of a shorter treatment time, supports its ongoing use in the eligible patient group. A randomised controlled trial would be necessary to more completely assess the acute and long-term toxicity of HFRT compared with standard fractionation.
authors.affiliation: Department of Radiation Oncology, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Dong-Hwan I
authors.initials: DH
authors.lastname: Ko
authors.forename: Andrew
authors.initials: A
authors.lastname: Norriss
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Harrington
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Robinson
authors.forename: Melissa L
authors.initials: ML
authors.lastname: James
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008408:Mastectomy / Q000401:mortality*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000517:prevention & control*; D009520:New Zealand / Q000453:epidemiology; D000069473:Radiation Dose Hypofractionation; D011855:Radiodermatitis / Q000401:mortality*; D018714:Radiotherapy, Adjuvant / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome
keywords: breast cancer; hypofractionation; radiation oncology