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Late-term effects of hypofractionated chest wall and regional nodal radiotherapy with two-dimensional technique in patients with breast cancer

Radiation Oncology Journal 2020년 38권 2호 p.109 ~ 118
Yadav Budhi Singh, Bansal Anshuma, Kuttikat Philip George, Das Deepak, Gupta Ankita, Dahiya Divya,
소속 상세정보
 ( Yadav Budhi Singh ) - Postgraduate Institute of Medical Education and Research Department of Radiation Oncology
 ( Bansal Anshuma ) - Rajindra Hospital Department of Radiation Oncology
 ( Kuttikat Philip George ) - Postgraduate Institute of Medical Education and Research Department of Radiation Oncology
 ( Das Deepak ) - Postgraduate Institute of Medical Education and Research Department of Radiation Oncology
 ( Gupta Ankita ) - Postgraduate Institute of Medical Education and Research Department of Radiation Oncology
 ( Dahiya Divya ) - Postgraduate Institute of Medical Education and Research Department of General Surgery

Abstract


Purpose: Hypofractionated radiotherapy (RT) is becoming a new standard in postoperative treatment of patients with early stage breast cancer after breast conservation surgery. However, data on hypofractionation in patients with advanced stage disease who undergo mastectomy followed by local and regional nodal irradiation (RNI) is lacking. In this retrospective study, we report late-term effects of 3 weeks post-mastectomy hypofractionated local and RNI with two-dimensional (2D) technique in patients with stage II and III breast cancer.

Methods: Between January 1990 and December 2007, 1,770 women with breast cancer who were given radical treatment with mastectomy, systemic therapy and RT at least 10 years ago were included. RT dose was 35 Gy/15 fractions/3 weeks to chest wall by two tangential fields and 40 Gy in same fractions to supraclavicular fossa (SCF) and internal mammary nodes (IMNs). SCF and IMNs dose was prescribed at dmax and 3 cm depth, respectively. Chemotherapy and hormonal therapy was given in 64% and 74% patients, respectively. Late-term toxicities were assessed with the Radiation Therapy Oncology Group (RTOG) scores and LENT-SOMA scales (the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic scales).

Results: Mean age was 48 years (range, 19 to 75 years). Median follow-up was 12 years (range, 10 to 27 years). Moderate/marked arm/shoulder pain was reported by 254 (14.3%) patients. Moderate/marked shoulder stiffness was reported by 219 (12.3%) patients. Moderate/marked arm edema was seen in 131 (7.4%) patients. Brachial plexopathy was not seen in any patient. Rib fractures were noted in 6 (0.3%) patients. Late cardiac and lung toxicity was seen in 29 (1.6%) and 23 (1.3%) patients, respectively. Second malignancy developed in 105 (5.9%) patients.

Conclusion: RNI with 40 Gy/15 fractions/3 weeks hypofractionation with 2D technique seems safe and comparable to historical data of conventional fractionation (ClinicalTrial.gov Registration No. NCT04175821).

키워드

Breast Cancer; Hypofractionation; Radiotherapy; Long-term effects; Postmastectomy

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