title: Hypofractionation with no boost after breast conservation in early-stage breast cancer patients.
abstract: The aim of this study was to evaluate local control, survival and toxicity profile of a consecutive cohort of early-stage breast cancer (EBC) patients treated with adjuvant hypofractionated radiotherapy (HF) with no boost delivered to the lumpectomy cavity, after breast-conserving surgery (BCS). Between 2005 and 2015, a total of 493 women affected with EBC were treated with HF (46 Gy/20 fractions or 40.05 Gy/15 fractions) to the whole breast without boost to tumor bed, because of age and/or favorable tumor characteristics. The primary endpoint was 5-year actuarial local control (LC); secondary endpoints included survival, toxicity profile and cosmesis. Median follow-up was 57 months (range 6-124). Actuarial 5-year overall, cancer-specific, disease-free survival and LC were 96.3, 98.9, 97.8 and 98.6 %, respectively. On multivariate analysis, tumor stage (T1 vs. T2) and hormonal status (positive vs. negative estrogen receptors) were significantly correlated with LC. Only 2 % of patients experienced ≥G3 acute skin toxicity. Late toxicity was mild with only 1 case of G3 fibrosis. Most of the patients (95 %) had good-excellent cosmetic results. HF to the whole breast with no boost delivered to the tumor bed is a safe and effective option for a population of low-risk breast cancer patients after BCS, with excellent 5-year LC, mild toxicity profile and promising cosmetic outcome. A subgroup of patients with larger tumors and/or with no estrogen receptor expression may potentially benefit from treatment intensification with a boost dose to the lumpectomy cavity.
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
authors: Francesca
authors: F
authors: Arcadipane
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy. pierfrancesco.franco@unito.it.
authors: Pierfrancesco
authors: P
authors: Franco
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
authors: Chiara
authors: C
authors: De Colle
authors: Department of Oncology, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy.
authors: Nadia
authors: N
authors: Rondi
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
authors: Jacopo
authors: J
authors: Di Muzio
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
authors: Emanuela
authors: E
authors: Pelle
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
authors: Stefania
authors: S
authors: Martini
authors: Department of General and Specialistic Surgery, Breast Surgery Unit, AOU Città della Salute e della Scienza, Turin, Italy.
authors: Ada
authors: A
authors: Ala
authors: Department of Oncology, Medical Oncology 2, AOU Città della Salute e della Scienza, Turin, Italy.
authors: Mario
authors: M
authors: Airoldi
authors: Department of Oncology, Breast Oncology Unit, AOU Città della Salute e della Scienza, Turin, Italy.
authors: Michela
authors: M
authors: Donadio
authors: Department of Gynecology and Obstetrics, Breast Unit, AOU Città della Salute e della Scienza, Turin, Italy.
authors: Corrado
authors: C
authors: De Sanctis
authors: Department of Medical Sciences, Pathology Unit, University of Torino, Turin, Italy.
authors: Isabella
authors: I
authors: Castellano
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
authors: Riccardo
authors: R
authors: Ragona
authors: Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy.
authors: Umberto
authors: U
authors: Ricardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D000069473:Radiation Dose Hypofractionation; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies
keywords: Adjuvant therapy; Boost; Breast cancer; Hypofractionated radiotherapy; Hypofractionation; Local control