Hypofractionated radiotherapy for breast cancer acceleration of the START A treatment regime: intermediate tolerance and efficacy

Abstract

PurposeProspective evaluation of accelerated hypofractionated radiotherapy (RT) in breast cancer patients treated with 41.6 Gy in 13 fractions plus boost delivered five times a week.Patients and methodsBetween 03/2009 and 10/2012 98 consecutive patients aged >55 years presenting with breast cancer (invasive cancer: n = 95, ductal carcinoma in situ (DCIS): n = 3) after breast conserving surgery were treated in our institution with the following schedule: 41.6 Gy in 13 fractions 4 times a week and 9 or 12 Gy boost in 3 or 4 fractions (on day 5 each week), cumulative dose: 50.6 Gy in 3.2 weeks or 53.6 Gy in 3.4 weeks, respectively depending on resection status. 56 patients had a T1 tumor, 39 a T2 tumor. N-status was as follows: N0: n = 71, N1: n = 25, N2/3: n = 2. 23 patients (24%) received chemotherapy before RT. A prospectively planned follow-up (FU) visit with objective and subjective assessment of treatment tolerance (questionnaires) was performed 0 and 8 weeks after RT completion, and one, two and four years later, respectively.ResultsMean/median follow-up was 32/28 months (range: 12-56). After 2 years local control, loco-regional control and disease-free survival was 100%, 100%, and 98%, respectively. Overall survival was 96% at 2 years. Cosmetic outcome was very good with patients being satisfied or very satisfied in 99% (n = 86/87), 97% (n = 55/57) and 100% (n = 25/25) after one, two and four years after RT, respectively. No grade ≥ 2 pain was described in the 25 patients with a FU of at least 4 years. Fibrosis, telangiectasia and edema were found in 7-15%, 0-22% and 0-11% at one, two, and four years, respectively, and are comparable to other trials.ConclusionThe applied hypofractionated RT regime with single doses of 3.2 Gy plus boost doses of 9-12 Gy in 3–4 fractions applied in 5 sessions a week was effective and well tolerated on intermediate term FU.

A Comparative Study of Daily 3-Gy Hypofractionated and 1.8-Gy Conventional Breast Irradiation in Early-Stage Breast Cancer

“…Nonetheless, in addition to the phase II prospective trial on our regimen that we have reported earlier, the data are constantly being accumulated. 10 The interim efficacy of 41.6 Gy in 13 fractions and then sequential boost with the same regime as ours reported by Janssen et al 20 was a local control rate of 100% at 2 years.…”

Évolution des pratiques médicales d’hypofractionnement en radiothérapie pour cancer du sein et impact économique

“…Après irradiation totale du sein, certaines études évaluent l'ajout de la surimpression avec l'hypofractionnement [15]. Le boost semble réa-lisable sans réaction cutanée inacceptable [10,11]. L'intérêt de ces études ne sera réel que si elles passent dans la pratique quotidienne.…”

“…Pour ces raisons, le schéma en 15 séances a pu être préféré à ceux en 13 séances. Enfin, des études récentes ont montré la possibilité d'un boost tumoral, avec des résultats cosmétiques acceptables, permettant de considérer une extension des indications de l'hypofractionnement [10,11].…”

The effect of nutrition counseling on nutritional status for breast cancer patients in dr. Sardjito Hospital, Indonesia

“…We measured physical ability using the HGS. At the time of anthropometric measurement, after completing all measurements above, the participants were asked to grab a hand dynamometer with the arm position perpendicular to the axial [20][21] . Next, handgrip strength was measured twice with 2 minutes interval using a hand dynamometer.…”