Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule

Jagsi, Reshma; Griffith, Kent A.; Boike, Thomas; Walker, Eleanor M.; Nurushev, T; Grills, I.S.; Moran, Jean M.; Feng, Mary; Hayman, James A.; Pierce, Lori J.

doi:10.1001/jamaoncol.2015.2590

Cited by 126 publications

(75 citation statements)

References 34 publications

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“…The main motivation for developing protracted radiotherapy regimens was the benefit to patients and health services in terms of convenience and cost. Recent breast cancer studies suggested that HF is also associated with a significantly lower acute skin reaction rate compared with CF [7, 24, 25]. Our study revealed another advantage of HF over CF: a significantly better patient compliance with the prescribed radiotherapy schedule.…”

Section: Discussionsupporting

confidence: 49%

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

et al. 2017

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BackgroundThe aim of the study was to identify factors significantly associated with the occurrence of unintended treatment interruptions in adjuvant breast cancer radiotherapy.Patients and methodsPatients treated with postoperative radiotherapy of the breast or chest wall between March 2014 and August 2016 were evaluated. The radiotherapy regimens and techniques applied were either conventional fractionation (CF; 28 daily fractions of 1.8 Gy or 25 fractions of 2.0 Gy) or hypofractionation (HF; 15 daily fractions of 2.67 Gy) with inverse planned intensity-modulated radiotherapy (IMRT) or three-dimensional planned conformal radiotherapy (3DCRT). Logistic regression analysis was used to identify factors associated with noncompliance. Noncompliance was defined as the missing of at least one scheduled radiotherapy fraction.ResultsIn all, 19 of 140 (13.6%) patients treated with HF and 39 of 146 (26.7%) treated with CF experienced treatment interruptions. Of 23 factors tested, the fractionation regimen emerged as the only independent significant prognostic factor for noncompliance on multivariate analysis (CF; p = 0.007; odds ratio, 2.3; 95% confidence interval, 1.3–4.2). No statistically significant differences concerning the reasons for treatment interruptions could be detected between patients treated with CF or HF.ConclusionHF is significantly associated with a better patient compliance with the prescribed radiotherapy schedule compared with CF. The data suggest that this finding is basically related to the shorter overall treatment time of HF.

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Section: Discussionsupporting

confidence: 49%

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

et al. 2017

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“…The two UK trials also showed that HF-WBI has similar or less late toxicities to normal breast tissues, compared to conventional radiotherapy [6]. Recently, two studies conducted in the US demonstrated that HF-WBI had significantly lower rates of early toxicities than conventional radiotherapy [18, 19], and a 2-year follow-up of the clinical trial in the US showed that patient-reported quality of life and physician-assessed cosmetic outcomes were similar between HF-WBI and CF-WBI arms [20]. Therefore, there should be no fear for toxicities to adopt HF-WBI.…”

Section: Discussionmentioning

confidence: 99%

Utilization trend and regimens of hypofractionated whole breast radiation therapy in the United States

Hasan

Waller

Yao

et al. 2017

Breast Cancer Res Treat

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Purpose We aimed to evaluate the adoption of hypofractionated whole breast irradiation (HF-WBI) over time and factors related to its adoption for patients undergoing lumpectomy. We also examined whether HF-WBI can increase the overall use of radiotherapy. Methods Using data from the National Cancer Database between 2004 and 2013, we identified 528,051 invasive and 190,431 ductal carcinoma in situ (DCIS) patients who underwent lumpectomy. HF-WBI was defined as 2.5-3.33 Gy/fraction to the breast, whereas conventional therapy (CF-WBI) was defined as 1.8-2.0 Gy/fraction. Results The usage of HF-WBI among invasive cancer patients increased from 0.7% in 2004 to 15.6% in 2013 and among DCIS patients, HF-WBI increased from 0.4% in 2004 to 13.4% in 2013. However, these changes only leaded to a slight increase in the overall use of radiotherapy. Interestingly, for DCIS patients who lived ≥50 miles from hospitals, the uptake of HF-WBI translated to a moderate increase in the overall use of radiotherapy (58% in 2004 to 63% in 2013). Multivariable logistic regression showed that older age, node negative or smaller tumor, living in mountain states, rural area or ≥50 miles from hospitals, and treated in large or academic cancer centers were associated with elevated HF-WBI use. The median duration of finishing radiotherapy for HF-WBI was 26 days, compared to 47 days for CF-WBI. Conclusions Although HF-WBI can save 3 weeks of patient time, its adoption remained low in the US. There was only a slight increase in the overall use of radiotherapy among patients undergoing lumpectomy.

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“…Despite the theoretically higher risk of late side effects, hypofractionation may provide benefits regarding the treatment-related quality of life and acute toxicity [10]. In study by Jagsi et al [11], patients who underwent hypofractionated whole breast radiotherapy presented with less acute pain, fatigue and dermatitis than patients who had received conventionally fractionated treatment.…”

Section: Introductionmentioning

confidence: 99%

Hematological Toxicity of Hypofractionated Radiotherapy: A Review of the Available Evidence

Spałek

2018

Oncol Res Treat

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Hypofractionated radiotherapy is commonly used to treat many cancers. The number of indications for this fractionation schedule is increasing. Knowledge of the potential hematological toxicity arising from hypofractionated irradiation is vital since many patients receive further systemic treatment. This review analyzes the available evidence on the effect of hypofractionated radiotherapy on hematological toxicity. However, radiobiological data on bone marrow responses to high doses of radiation per fraction are sparse. Additional biological effects may also play an significant role in bone marrow function and recovery after hypofractionated radiotherapy. Clinical data show a good early hematological tolerance of hypofractionated radiotherapy (both large field and for stereotactic body radiotherapy). There are, however, no data available that assess late hematological toxicity. Evidence on acute hematological toxicity after hypofractionated radiotherapy does not suggest any significant impact of altered fractionation on early treatment tolerance, although further research to assess this problem is needed. The effect of hypofractionation on late hematological tolerance is unknown because the data are still lacking.

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Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation Schedule

Abstract: Hypofractionation not only improves convenience but also may reduce acute pain, fatigue, and the extent to which patients are bothered by dermatitis in patients with breast cancer undergoing whole-breast radiotherapy.

Cited by 126 publications

References 34 publications

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

Better compliance with hypofractionation vs. conventional fractionation in adjuvant breast cancer radiotherapy

Utilization trend and regimens of hypofractionated whole breast radiation therapy in the United States

Hematological Toxicity of Hypofractionated Radiotherapy: A Review of the Available Evidence

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