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. 2017 Apr-Jun;38(2):121-127.
doi: 10.4103/ijmpo.ijmpo_80_16.

Normal Tissue Complications following Hypofractionated Chest Wall Radiotherapy in Breast Cancer Patients and Their Correlation with Patient, Tumor, and Treatment Characteristics

Mohsin Khan  1 , Shahid A Siddiqui  1 , Manoj K Gupta  2 , Rajeev K Seam  2 , Manish Gupta  2
Affiliations

Normal Tissue Complications following Hypofractionated Chest Wall Radiotherapy in Breast Cancer Patients and Their Correlation with Patient, Tumor, and Treatment Characteristics

Mohsin Khan et al. Indian J Med Paediatr Oncol. 2017 Apr-Jun.

Abstract

Introduction: Normal tissue complications following chest wall radiotherapy (RT) are inevitable, and the long-term data on hypofractionation are still limited. To quantify the late effects of hypofractionated RT on cardiac, pulmonary, brachial plexus, and regional lymphatics and their correlation with patient, tumor, and treatment characteristics is the main objective of this study.

Materials and methods: Two hundred and sixteen breast cancer patients following mastectomy were treated with hypofractionated schedules either 40 Gy in 15 fractions or 42.5 Gy in 16 fractions. Common Toxicity Criteria version 3.0 was utilized to quantify the late effects of hypofractionation on cardiac, pulmonary, brachial plexus, and lymphedema at a maximum follow-up of 5 years.

Results: Median follow-up was 42 months. Median age was 49 years. 14.8% developed ≥Grade (Gr) 2 late cardiac toxicity. 10.2% developed ≥Gr2 late pulmonary toxicity. There were 28.7% patients who developed ≥Gr2 lymphedema. Sixty-seven out of 216 patients had symptomatic brachial plexopathy at 5-year follow-up. Variables found to increase the incidence of these adverse events included smoking, hypertension, diabetes mellitus, body mass index ≥25, extent of axillary dissection, and use of supraclavicular field.

Conclusion: Hypofractionation leads to increased risk of normal tissue complications partly influenced by some patient- and treatment-related factors, but these were manageable and minimally disabling.

Keywords: Breast cancer; hypofractionation; postmastectomy.

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Conflict of interest statement

There are no conflicts of interest.

References

    1. Fletcher GH. Clinical dose response curve of subclinical aggregates of epithelial cells and its practical application in the management of human cancer. In: Friedman M, editor. Biological and Clinical Basis of Radiosensitivity. Springfield, IL: Charles C Thomas; 1974. p. 485.
    1. START Trialists’ Group. Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: A randomised trial. Lancet Oncol. 2008;9:331–41. - PMC - PubMed
    1. START Trialists’ Group. Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: A randomised trial. Lancet. 2008;371:1098–107. - PMC - PubMed
    1. Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: Long-term results of a randomised trial. Lancet Oncol. 2006;7:467–71. - PubMed
    1. Whelan T, MacKenzie R, Julian J, Levine M, Shelley W, Grimard L, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94:1143–50. - PubMed