Conventional versus hypofractionated postmastectomy radiotherapy: a report on long-term outcomes and late toxicity
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RESEARCH
Open Access
Conventional versus hypofractionated postmastectomy radiotherapy: a report on long-term outcomes and late toxicity Imjai Chitapanarux1,2,3* , Pitchayaponne Klunklin1,2, Attapol Pinitpatcharalert4, Patumrat Sripan1,2,3, Ekkasit Tharavichitkul1,2, Wannapha Nobnop1,2, Wimrak Onchan1,2, Somvilai Chakrabandhu1,2, Bongkot Jia-Mahasap1,2, Juntima Euathrongchit5, Yutthaphan Wannasopha5 and Tanop Srisuwan5
Abstract Objective: We evaluated the long-term outcomes and late toxicity of conventional fractionated (CF) and hypofractionated (HF) postmastectomy radiotherapy (PMRT) in terms of locoregional recurrence-free survival (LRRFS), disease-free survival (DFS), overall survival (OS), and late toxicity. Methods: A cohort of 1640 of breast cancer patients receiving PMRT between January 2004 and December 2014 were enrolled. Nine hundred eighty patients were treated with HF-PMRT: 2.65 Gy/fraction to a total of 42.4–53 Gy and 660 patients were treated with CF-PMRT: 2 Gy/fraction to a total of 50–60 Gy. Results: The median follow-up time was 71.8 months (range 41.5–115.9 months). No significant difference was found in the rates of 5-year LRRFS, DFS, and OS of HF-PMRT vs CF-PMRT; 96% vs. 94% (p = 0.373), 70% vs. 72% (p = 0.849), and 73% vs. 74% (p = 0.463), respectively. We identified a cohort of 937 eligible breast cancer patients who could receive late toxicities assessment. With a median follow-up time of this patient cohort of 106.3 months (range 76–134 months), there was a significant higher incidence of grade 2 or more late skin (4% vs 1%) and subcutaneous (7% vs 2%) toxicity in patients treated with HF-PMRT vs CF-PMRT. Patients who received additional radiation boost were significantly higher in the HF-PMRT group. Grade 2 or more late RTOG/EORTC lung toxicity was significant lesser in HF-PMRT vs CF-PMRT (9% vs 16%). Grade 1 brachial plexopathy was also significant lesser in HF-PMRT vs CF-PMRT (2% vs 8%). Heart toxicity and lymphedema were similar in both groups. Conclusions: HF-PMRT is feasible to deliver with comparable long-term efficacy to CF-PMRT. HF-PMRT had higher grade 2 or more skin and subcutaneous toxicity but less lung and brachial plexus toxicity. Keywords: Long-term, Outcome, Toxicity, Conventional, Hypofractionated, Postmastectomy radiotherapy
Introduction Radiotherapy is one of the essential components of breast cancer treatment. After a mastectomy, radiotherapy as an adjuvant treatment has shown benefits in both locoregional control (LRC) and overall survival (OS) in many large randomized clinical trials and meta-analysis [1–4]. Generally, the standard radiation dose for * Correspondence: [email protected]; [email protected] 1 Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, 110 Intawarorose Road, Chiang Mai 50200, Thailand 2 Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand Full list of author information is available at the end of the article
postmastectomy radiotherapy
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