Late Effects and Cosmetic Results of Conventional Versus Hypofractionated Irradiation in Breast-Conserving Therapy

Department of Radiation Oncology, University Medical Clinic Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Strahlentherapie und Onkologie (Impact Factor: 2.91). 10/2005; 181(10):625-31. DOI: 10.1007/s00066-005-1404-9
Source: PubMed


Breast irradiation after lumpectomy is an integral component of breast-conserving therapy (BCT). As the prognosis is general good following BCT, late morbidity and cosmesis are important. The present study compares two different radiation schedules with respect to these two endpoints.
129 breast cancer patients (pT1-2 pN0-1 cM0) were irradiated between 09/1992 and 08/1994 with either a 22-day fractionation schedule (2.5 Gy to 55 Gy, 4x/week, n = 65) or with a conventional fractionation schedule (28 days, 2.0 Gy to 55 Gy, 5x/week, n = 64), both without additional boost. The equivalent dose of 2-Gy fractions (EQD2) was 55 Gy and 62 Gy, respectively. Late toxicity, assessed according to the LENT-SOMA criteria, and cosmetic outcome, graded on a 5-point scale, were evaluated after a median of 86 months (range 72-94 months) in tumor-free breast cancer patients.
LENT-SOMA grade 2/3 toxicity (2.5 Gy vs. 2.0 Gy): breast pain (18% vs. 11%; p = 0.3), fibrosis (57% vs. 16%; p < 0.001), telangiectasia (22% vs. 3%; p = 0.002), atrophy (31% vs. 3%; p < 0.001). Medication to breast pain was taken by 8% versus 9% of patients. Cosmesis was very good/good/acceptable in 75% versus 93% (2.5 Gy vs. 2.0 Gy; p = 0.006).
Late morbidity was significantly frequent and cosmesis was significantly worse after hypofractionated radiotherapy (2.5 Gy to 55 Gy). However, morbidity was not associated with major implications on daily life.

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    • "Hypofractionated regimens without a compensatory decrease in total dose may lead to increased rates of arm oedema. One retrospective comparison reported a 15% incidence after hypofractionated treatment to 55e60 Gy compared with 6% after conventional fractionation to the same total dose [27]. Similarly, rates of significant lymphoedema were low (approximately 6e8%) and were not increased with hypofractionated radiotherapy in the study of the RMH/GOC (axillary surgery performed in 59% of patients) or the Hôpital Necker trials (rate of axillary surgery not reported) [13] [28]. "
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    ABSTRACT: The demand for breast cancer care has increased as cancer treatment innovations have proliferated. Adjuvant radiotherapy to the breast is considered to be part of the standard treatment in breast cancer. The role of radiotherapy in terms of reducing loco-regional recurrence and increased survival after conservative surgery, and also after a mastectomy in selected cases, has been previously shown in several randomized trials. Patterns of radiotherapy commonly used for breast cancer comprise a period of approximately five weeks, frequently with the addition of an additional 1–1.5 weeks of a radiation boost to the primary tumour area. In last years, there has been a renewed interest in hypofractionated and accelerated radiotherapy schedules that reduce the overall treatment time to barely three weeks, leading to an improvement in quality of life for patients and also optimizing workload of radiation oncology departments. However, despite the existing evidence supporting the use of hypofractionated treatment regimens, their widespread is still far from complete. Many questions have generated resistance among clinical oncologists for their regular use. The aim of this review is to answer those questions that may arise with the use of moderate hypofractionation in breast cancer.
    Breast (Edinburgh, Scotland) 08/2014; 23(4). DOI:10.1016/j.breast.2014.01.011 · 2.38 Impact Factor
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    • "This is in large part due to the fact that currently there is no consensus regarding optimal methods of measurement of cosmetic outcome following BCT.4,5 Numerous researchers from different disciplines, including plastic surgery,8,9 surgical oncology,10 radiation oncology,1,3,11–15 and even multidisciplinary teams,16–20 have assessed cosmetic outcomes, using a variety of techniques. The vast majority of studies have evaluated results using some variation of a 4-point rating scale, frequently in conjunction with a questionnaire that evaluates a global form of cosmesis. "
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    ABSTRACT: Background: One of the primary benefits of breast conserving therapy (BCT) is the potential ability to preserve the aesthetic appearance of the breast. However, current literature and clinical experience suggest that the aesthetic benefits of BCT may not be equally shared among ethnic groups. This is a pilot study that uses novel techniques to evaluate the cosmetic outcomes of African American and white women following BCT. Methods: A total of 21 participants (10 African American and 11 white) completed the study. Cosmetic outcomes following BCT were evaluated by a multidisciplinary team using both quantitative and qualitative measures, including 3-dimensional photographic analysis and a pilot questionnaire. Preliminary measures were taken to evaluate the validity of the questionnaire. Results: There were no statistically significant differences in objective measures of breast symmetry between African American patients and white patients (P > 0.05 in all cases). However, all raters reported the African American patients to have worse breast symmetry and appearance when compared with white patients. Interrater reliability was found to be fair with regard to the nipple complex questions [intraclass correlation (ICC), 0.56], good with regard to the breast mound questions (ICC, 0.66), and poor with regard to the scar appearance questions (ICC = 0.32). Conclusions: Although generalizing the results of this study is limited by the small sample size, it seems that there is a difference in the perception of cosmetic outcomes between white and African American patients. The novel techniques of cosmetic evaluation used in this study show promise toward identifying variables that can affect cosmetic outcome following BCT.
    01/2014; 2(1):e94. DOI:10.1097/GOX.0000000000000013
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    • "During treatment, the decrease of the target dose homogeneity significantly increased acute skin toxicity [22]. In addition, compared with conventional radiotherapy, hypofractionated whole breast irradiation (HF-WBI) which increasing the prescription dose per fraction delivered has been investigated recently [23–25]. The dose inhomogeneities and inconformities in irradiated volumes strongly influence radiation-induced toxicities, hence the target position during treatment with HF-WBI has to be determined with high precision. "
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    ABSTRACT: This study was performed to explore and compare the dosimetric variance caused by respiratory movement in the breast during forward-planned IMRT after breast-conserving surgery. A total of 17 enrolled patients underwent the 3DCT simulation scans followed by 4DCT simulation scans during free breathing. The treatment planning constructed using the 3DCT images was copied and applied to the end expiration (EE) and end inspiration (EI) scans and the dose distributions were calculated separately. CTV volume variance amplitude was very small (11.93 ± 28.64 cm(3)), and the percentage change of CTV volumes receiving 50 Gy and 55 Gy between different scans were all less than 0.8%. There was no statistically significant difference between EI and EE scans (Z = -0.26, P = 0.795). However, significant differences were found when comparing the D(mean) at 3DCT planning with the EI and EE planning (P = 0.010 and 0.019, respectively). The homogeneity index at EI, EE and 3D plannings were 0.139, 0.141 and 0.127, respectively, and significant differences existed between 3D and EI, and between 3D and EE (P = 0.001 and 0.006, respectively). The conformal index (CI) increased significantly in 3D treatment planning (0.74 ± 0.07) compared with the EI and EE phase plannings (P = 0.005 and 0.005, respectively). The V(30), V(40), V(50) and D(mean) of the ipsilateral lung for EE phase planning were significantly lower than for EI (P = 0.001-0.042). There were no significant differences in all the DVH parameters for the heart among these plannings (P = 0.128-0.866). The breast deformation during respiration can be disregarded in whole breast IMRT. 3D treatment planning is sufficient for whole breast forward-planned IMRT on the basis of our DVH analysis, but 4D treatment planning, breath-hold, or respiratory gate may ensure precise delivery of radiation dose.
    Journal of Radiation Research 01/2013; 54(4). DOI:10.1093/jrr/rrs143 · 1.80 Impact Factor
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