title: Hypofractionated Regional Nodal Irradiation for Women With Node-Positive Breast Cancer.
abstract: To evaluate the effect of hypofractionated radiation therapy (HFRT) of the breast/chest wall and regional nodes on overall survival (OS), disease-free survival (DFS), locoregional control and on treatment-related toxicity in patients with breast cancer and nodal involvement.
  
  
  
  Two hundred fifty-seven patients treated between October 2009 and June 2011 with hypofractionated locoregional radiation therapy (42 Gy in 15 fractions) were retrospectively reviewed, 51 (19.8%) after breast-conserving surgery and 206 (80.2%) after radical surgery. Patients treated with breast-conserving surgery received a boost dose to the tumor bed (delivered by photons, electrons, or interstitial high-dose-rate brachytherapy). Two hundred fifty-six (99.6%) patients underwent chemotherapy, 209 (81.3%) had hormonal treatment, and 65 (25.3%) had anti-HER2 targeted therapy.
  
  
  
  The median follow-up time was 64 months (range, 11-88 months). The rates of 5-year OS, DFS, locoregional recurrence (LRR)-free survival, and distant metastasis (DM)-free survival were 86.6%, 84.4%, 93.9%, and 83.1%, respectively. In multivariate analysis (MVA), lymph node ratio >65%, lymphovascular invasion, and negative hormone receptor status predicted for OS, DSF, and DM. T3 to 4 stage was also associated with worse DFS and DM. Finally, for LRR the independent prognostic factors on MVA were N2 to 3 stage and grade 3. Hyperpigmentation was observed in 19.2% of patients, telangiectasia in 12.3%, and fibrosis in 30.7%. Grade ≥2 lymphedema was recorded in 5.8% of cases. During the study follow-up, no cardiac or symptomatic pneumonitis was observed, nor were plexopathy or rib fractures.
  
  
  
  According to the findings from this retrospective study, HFRT seems to be an acceptable alternative for patients with breast cancer who need regional nodal irradiation. However, prospective randomized trials are necessary to confirm these preliminary results.
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco. Electronic address: sara.bellefqih@gmail.com.
authors.forename: Sara
authors.initials: S
authors.lastname: Bellefqih
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Sanaa
authors.initials: S
authors.lastname: Elmajjaoui
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Jihan
authors.initials: J
authors.lastname: Aarab
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Jihane
authors.initials: J
authors.lastname: Khalil
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Afif
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Amine
authors.initials: A
authors.lastname: Lachgar
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Hanan
authors.initials: H
authors.lastname: El Kacemi
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Tayeb
authors.initials: T
authors.lastname: Kebdani
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Mohammed V University, Rabat, Morocco.
authors.forename: Noureddine
authors.initials: N
authors.lastname: Benjaafar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001940:Breast; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017495:Hyperpigmentation / Q000209:etiology; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods*; D008207:Lymphatic Metastasis; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D000069473:Radiation Dose Hypofractionation; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D013684:Telangiectasis / Q000209:etiology; D013909:Thorax; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human