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Comparison of conventional and hypofractionated radiation after mastectomy in locally advanced breast cancer: a prospective randomised study on dosimetric evaluation and treatment outcome

Published online by Cambridge University Press:  17 January 2020

Sumana Maiti ,
Suman Meyur Open the ORCID record for Suman Meyur [Opens in a new window] ,
Bidhan Chandra Mandal ,
Lekshmi R Shenoi ,
Susmita Biswas  and
Siddhartha Basu
Sumana Maiti
Affiliation:
Department of Radiotherapy and Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
Suman Meyur*
Affiliation:
Department of Radiotherapy and Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
Bidhan Chandra Mandal
Affiliation:
Department of Radiotherapy and Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
Lekshmi R Shenoi
Affiliation:
Department of Radiotherapy and Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
Susmita Biswas
Affiliation:
Department of Radiotherapy and Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
Siddhartha Basu
Affiliation:
Department of Radiotherapy and Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
*
Author for correspondence: Dr Suman Meyur, Department of Radiotherapy and Oncology, Institute of Post-Graduate Medical Education and Research, Kolkata, India. Mobile: +91 9674457101. E-mail: [email protected]
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Abstract

Background:

Although hypofractionated radiotherapy has been standardised in early breast cancer, even in post-mastectomy no such consensus has been developed for locally advanced breast cancer (LABC), probably due to complex planning and field matching. This study is directed towards dosimetric evaluation and comparison of toxicity, response and disease-free survival (DFS) comparison between hypofractionation and conventional radiotherapy in post-mastectomy LABC.

Methodology:

In total, 222 female breast cancer patients were randomly assigned to be treated with either hypofractionated radiotherapy (n = 120) delivering 40 Gy in 15 fractions over 3 weeks or conventional radiotherapy (n = 102) with 50 Gy in 25 fractions over 5 weeks after modified radical mastectomy (MRM) along with neoadjuvant and/or adjuvant chemotherapy. All patients were planned with treatment planning software and assessed regularly during and after treatment.

Results:

Median follow-up period was 178 weeks in conventional arm (CRA) and 182 weeks in hypofractionation arm (HFA). There exists a dosimetric difference between the two arms of treatment, in spite of similar dose coverage [planning treatment volume (PTV) D90 92·04% in CRA versus 92·5% in HFA; p = 0·49], average dose in HFA is less than that of CRA (p < 0·001); so is the maximum clinical target volume (CTV) dose (p < 0·001). Similarly, average lung dose in HFA arm is significantly lower than CRA (9·9 versus 10·84; p = 0·06), but the V20Gy of lung and V30Gy of heart had no difference. The toxicity of radiation was comparable with similar mean time to produce toxicity [CRA: 7 W, HFA: 10 W; hazard ratio 0·64, 95% confidence interval (CI) = 0·28–1·45]. Three-year recurrence event was alike in two arms (CRA: 4·9%, HFA: 5·8%; p = 0·76). Mean DFS in CRA is 230 weeks and that of HFA is 235 weeks with hazard ratio 1·01 (95% CI = 0·32–3·19; p = 0·987).

Conclusion:

Though biologically effective dose (BED) in hypofractionation is lesser than that of conventional fractionation, there are indistinguishable toxicity, locoregional recurrence, distant failure rate and DFS between the two modalities.

Keywords

disease-free survivalhypofractionationlocally advanced breast cancerpost-mastectomy radiotherapyradiation toxicity
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 20 , Issue 1 , March 2021 , pp. 30 - 38
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Copyright
© The Authors, 2020. Published by Cambridge University Press

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