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. 2014 Apr 24:9:97.
doi: 10.1186/1748-717X-9-97.

Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors

Patrizia Ciammella  1 , Ala Podgornii, Maria Galeandro, Renato Micera, Dafne Ramundo, Tamara Palmieri, Elisabetta Cagni, Cinzia Iotti
Affiliations

Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors

Patrizia Ciammella et al. Radiat Oncol. .

Abstract

Purpose: The objective of this study is to evaluate toxicity and cosmetic outcome in breast cancer patients treated with adjuvant hypo fractionated radiotherapy to the whole breast, and to identify the risk factors for toxicity.

Methods and materials: Two hundred twelve women with early breast cancer underwent conserving surgery were enrolled in the study. The patients received 40.05 Gy in 15 daily fractions, 2.67 Gy per fraction. The boost to the tumor bed was administered with a total dose of 9 Gy in 3 consecutive fractions in 55 women. Physician-rated acute and late toxicity and cosmetic outcome (both subjective and objective) were prospectively assessed during and after radiotherapy.

Results: In our population study the mean age was 63 with the 17% (36 pts) of the women younger than 50 years.The median follow-up was 34 months. By the end of RT, 35 patients out of 212 (16%) no acute toxicity, according to the RTOG criteria, while 145 (68%) and 31 patients (15%) developed grade 1 and grade 2 acute skin toxicity, respectively.Late skin toxicity evaluation was available for all 212 patients with a minimum follow up of 8 months. The distribution of toxicity was: 39 pts (18%) with grade 1 and 2 pts (1%) with grade 2. No worse late skin toxicity was observed.Late subcutaneous grade 0-1 toxicity was recorded in 208 patients (98%) and grade 2 toxicity in 3 patients (2%), while grade 3 was observed in 1 patient only. At last follow up, a subjective and objective good or excellent cosmetic outcome was reported in 93% and 92% of the women, respectively. At univariate and multivariate analysis, the late skin toxicity was correlated with the additional boost delivery (p=0.007 and p=0.023). Regarding the late subcutaneous tissue, a correlation with diabetes was found (p=0.0283).

Conclusion: These results confirm the feasibility and safety of the hypofractionated radiotherapy in patients with early breast cancer. In our population the boost administration was resulted to be a significant adverse prognostic factor for acute and late toxicity. Long-term follow up is need to confirm this finding.

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Figures

Figure 1
Figure 1
Distribution of acute skin toxicity (AST), late skin toxicity (LST) and late subcutaneous toxicity (LSCT).
Figure 2
Figure 2
Distribution of (A) objective (OCO) and (B) subjective cosmetic outcome (SCO): (A) excellent cosmeses, (B) good cosmeses, (C) fair cosmeses and (D) poor cosmeses.
Figure 3
Figure 3
Examples of objective cosmetic results (arms up and arms down): (A) excellent cosmeses, (B) good cosmeses, (C) fair cosmeses and (D) poor cosmeses.
See this image and copyright information in PMC

References

    1. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E, Godwin J, Gray R, Hicks C, James S, MacKinnon E, McGale P, McHugh T, Peto R, Taylor C, Wang Y. for the Early Breast Cancer Trialists' Collaborative Group (EBCTCG) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366:2087–2106. - PubMed
    1. Cuzick J. Rdaiotherapy for breast cancer. J Natl Cancer Inst. 2005;97:406–407. doi: 10.1093/jnci/dji086. - DOI - PubMed
    1. Nielsen HM, Overgaard M, Grau C, Jensen AR, Overgaard J. Study of failure pattern among high-risk berast cancer patients with or without postmastectomy radiotherapy in addition to adjuvant systemic therapy: long-term results from Danish Breast Cancer Cooperative Group DBCG 82 b and c randomized studies. J Clin Oncol. 2006;24:2268–2275. doi: 10.1200/JCO.2005.02.8738. - DOI - PubMed
    1. Van de Steen J, Soete G, Storme G. Adjuvant radiotherapy for breast cancer significantly improves overall survival: the missing link. Radiother Oncol. 2000;55:263–272. doi: 10.1016/S0167-8140(00)00204-8. - DOI - PubMed
    1. Vinh-Hung V, Verschraegen C. The Breast Conserving Surgery Project. Breast conserving surgery with or without radiotherapy: pooled-analysis for risks of ispilateral breast tumor recurrence and mortality. J Natl Cancer Inst. 2004;96:115–121. doi: 10.1093/jnci/djh013. - DOI - PubMed

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