Hypofractionated irradiation of infra-supraclavicular lymph nodes after axillary dissection in patients with breast cancer post-conservative surgery: impact on late toxicity.
BACKGROUND
The aim of the present work was to analyse the impact of mild hypofractionated radiotherapy (RT) of infra-supraclavicular lymph nodes after axillary dissection on late toxicity.


METHODS
From 2007 to 2012, 100 females affected by breast cancer (pT1- T4, pN1-3, pMx) were treated with conservative surgery, Axillary Node Dissection (AND) and loco-regional radiotherapy (whole breast plus infra-supraclavicular fossa). Axillary lymph nodes metastases were confirmed in all women. The median age at diagnosis was 60 years (range 34-83). Tumors were classified according to molecular characteristics: luminal-A 59 pts (59%), luminal-B 24 pts (24%), basal-like 10 pts (10%), Her-2 like 7 pts (7%). 82 pts (82%) received hormonal therapy, 9 pts (9%) neo-adjuvant chemotherapy, 81pts (81%) adjuvant chemotherapy. All patients received a mild hypofractionated RT: 46 Gy in 20 fractions 4 times a week to whole breast and infra-supraclavicular fossa plus an additional weekly dose of 1,2 Gy to the lumpectomy area. The disease control and treatment related toxicity were analysed in follow-up visits. The extent of lymphedema was analysed by experts in Oncological Rehabilitation.


RESULTS
Within a median follow-up of 50 months (range 19-82), 6 (6%) pts died, 1 pt (1%) had local progression disease, 2 pts (2%) developed distant metastasis and 1 subject (1%) presented both. In all patients the acute toxicity was mainly represented by erythema and patchy moist desquamation. At the end of radiotherapy 27 pts (27%) presented lymphedema, but only 10 cases (10%) seemed to be correlated to radiotherapy. None of the patients showed a severe damage to the brachial plexus, and the described cases of paresthesias could not definitely be attributed to RT. We did not observe symptomatic pneumonitis.


CONCLUSIONS
Irradiation of infra-supraclavicular nodes with a mild hypofractionated schedule can be a safe and effective treatment without evidence of a significant increase of lymphedema appearance radiotherapy related.
Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy. marina.guenzi@hsanmartino.it.
Marina
M
Guenzi
Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy. blandinog.81@gmail.com.
Gladys
G
Blandino
Department of Oncological Rehabilitation - IRCCS A.O.U. San Martino - IST, Genoa, Italy. mariagiuseppina.vidili@hsanmartino.it.
Maria Giuseppina
MG
Vidili
Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy. aloideborah@yahoo.it.
Deborah
D
Aloi
Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy. ele.confy@virgilio.it.
Elena
E
Configliacco
Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy. verzanini.elisa@libero.it.
Elisa
E
Verzanini
Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy. ele.tornari@gmail.com.
Elena
E
Tornari
Department of Medical Physics - IRCCS A.O.U. San Martino - IST, Genoa, Italy. Francesca.cavagnetto@hsanmartino.it.
Francesca
F
Cavagnetto
Department of Radiotherapy - IRCCS A.O.U. San Martino - IST, Genoa, Italy. renzo.corvo@unige.it.
Renzo
R
Corvò
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000528:radiation effects; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy*; D008209:Lymphedema / Q000453:epidemiology* / Q000209:etiology; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D000069473:Radiation Dose Hypofractionation; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects*; D012189:Retrospective Studies