Hypofractionated whole breast irradiation after conservative surgery for patients aged less than 60 years: a multi-centre comparative study

Meattini, Icro; Poortmans, Philip; Kirova, Youlia; Saieva, Calogero; Visani, Luca; Salvestrini, Viola; Kim, Jiyoung; Jung, Wonguen; Olmetto, Emanuela; Mariotti, Matteo; Desideri, Isacco; Livi, Lorenzo; Kim, Kyubo

doi:10.1080/0284186x.2019.1695061

Cited by 10 publications

(8 citation statements)

References 31 publications

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“…However, adjuvant chemotherapy was broadly used in the MD Anderson [30] and Chinese trials [19], with acceptable side effects and no differences between fracxtionation schedules. Moreover, in a real-life practice, the use of moderately hypofractionated irradiation in young patients was associated with excellent clinical outcomes [31]. This is in agreement with the European Society for Radiotherapy and Oncology (ESTRO) Advisory Committee in Radiation Oncology Practice (ACROP) consensus recommendations that advise moderately hypofractionated irradiation for all patients [32].…”

Section: Discussionsupporting

confidence: 79%

Moderately hypofractionated post-operative radiation therapy for breast cancer: Systematic review and meta-analysis of randomized clinical trials

et al. 2022

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Introduction:We provide a critical assessment regarding current evidence for the use of moderately hypofractionated irradiation for patients with breast cancer. The aim of the study was to summarize the available evidence regarding outcomes after moderately hypofractionated compared with conventional radiation doses in the post-operative treatment of patients with breast cancer. Material and methods: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and LILACS databases were searched until March 25, 2021. All randomized phase 3 clinical trials that compared moderately hypofractionated with conventional radiation doses in the post-operative treatment of patients with breast cancer were selected. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Results: Eight clinical trials satisfied the eligibility criteria and were the focus of the analysis. A total of 12,139 breast cancer patients was randomly assigned for moderately hypofractionated compared with conventional irradiation. Meta-analysis of the trials regarding local recurrence, loco-regional recurrence, disease-free survival, and overall survival outcomes did not demonstrate any significant difference between moderately hypofractionated irradiation and conventional radiation doses groups. The rate of severe side effects was low in both groups; acute and late side effects and cosmesis were similar or even tended to be lower after moderately hypofractionated than after conventional irradiation. Conclusions: Moderately hypofractionated is at least as effective and safe as conventional radiation irradiation regimens and should be considered as a treatment option for most, if not all, breast cancer patients.PROSPERO REGISTER: CRD42021237630. IntroductionPost-operative radiation therapy (RT) is a key oncologic treatment for patients with breast cancer receiving either mastectomy or breast-* Corresponding author.

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Section: Discussionsupporting

confidence: 79%

Moderately hypofractionated post-operative radiation therapy for breast cancer: Systematic review and meta-analysis of randomized clinical trials

et al. 2022

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“…Administration of a sequential boost to the tumor bed was associated with higher edema scores in the studies by Barnett et al, La Rocca et al, and Meattini et al (respectively, OR 1.71 95%CI 1.20–2.43, 1.70 95%CI 1.08–2.67, and 9.02 (95%CI 1.21–67.45)) ( Table 6 ) [ 22 , 24 , 26 ]. In addition, a significant association between higher boost volume and edema was seen in one study (OR 1.21 95%CI 1.09–1.33) [ 40 ].…”

Section: Resultsmentioning

confidence: 92%

“…A radiotherapy dose of 50 Gy in 25 fractions resulted in a 12.5 times higher odds ratio than a dose of 30 Gy in 5 fractions (95%CI 2.73–57.13) [ 21 ]. However, three other studies found no significant association between radiotherapy dose or irradiated volume and fibrosis (Supplementary table B ) [ 24 , 36 , 38 ]. Two studies found a significant association between (breast) pain and administration of additional radiotherapy boost on the tumor bed (respectively, OR 1.38 (95%CI 1.04–1.83) and 3.30 (95%CI 1.26–8.66)) ( Table 4 ) [ 22 , 39 ].…”

Section: Resultsmentioning

confidence: 98%

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Factors Associated with Late Local Radiation Toxicity after Post-Operative Breast Irradiation

et al. 2022

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Purpose. To assess determinants associated with late local radiation toxicity in patients treated for breast cancer. Methods. A systematic review was performed. All studies reporting ≥2 variables associated with late local radiation toxicity after treatment with postoperative whole breast irradiation were included. Cohort studies, randomized controlled trials, and cross-sectional studies were eligible designs. Study characteristics and definitions of determinants and outcome measures were extracted. If possible, the measure of association was extracted. Results. Twenty-one studies were included in this review. Six out of seven studies focused on the association between radiotherapy (boost) dose or irradiated breast volume and late radiation toxicity found significant results. Tumor bed boost was associated with late radiation toxicity, fibrosis, and/or edema in six out of twelve studies. Lower age was associated with late breast toxicity in one study, while in another study, higher age was significantly associated with breast fibrosis. Also, no association between age and late radiation toxicity was found in eight out of twelve studies. Similar inconsistent results were found in the association between late radiation toxicity and other patient-related factors (i.e., breast size, diabetes mellitus) and surgical and systemic treatment-related factors (i.e., complications after surgery, chemotherapy, and time between surgery and radiotherapy). Conclusion. In modern 3D radiotherapy, radiotherapy (boost) dose and volume are—like in 2D radiotherapy—associated with late local radiation toxicity, such as breast fibrosis and edema. Treatment de-escalation, for example, partial breast irradiation in selected patients might be important to decrease late local toxicity without compromising locoregional control and survival.

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“…Apart from modifying radiation techniques and developing new techniques, many authors have also studied modified fractionation in the management of breast radiation therapy. The conventional protocol comprising 50 Gy in 25 fractions has been progressively replaced by hypofractionated protocols [ 30 , 31 ], such as 40.05 Gy in 15 fractions or, more recently, 26 Gy in 5 fractions [ 32 ]. Another issue concerns the role of a boost [ 33 , 34 ], which can be either integrated or sequential [ 14 ].…”

Section: Resultsmentioning

confidence: 99%

Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review

Allali

Kirova

2021

Cancers

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Background: Radiation therapy has been progressively improved in order to maintain a satisfactory tumour response, while reducing toxicity. We will review the incidence of radiodermatitis and fibrosis according to the various radiation and fractionation techniques. We will then focus on the various methods used to manage, prevent, and quantify this toxicity. Method: More than 1753 articles were identified using the various search terms. We selected 53 articles to answer the questions addressed in this study according to criteria set in advance. Result: The literature reports lower acute toxicity with IMRT compared to 3DCRT, but no significant differences in terms of late toxicities. Partial breast irradiation appears to be less effective in terms of local control with a higher rate of late toxicity. Intra operative radiation therapy appears to provide good results in terms of both local control and late toxicity. The hypofractionation has equivalent efficacy and safety to the normofractionated regimen, but with lower rates of radiodermatitis and fibrosis. The adddition of a boost, particularly a sequential boost, increases the risk of fibrosis and radiodermatitis during treatment. Conclusion: The development of IMRT has significantly reduced acute toxicity and has improved tolerability during treatment. Modified fractionation has reduced treatment time, as well as adverse effects.

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Hypofractionated whole breast irradiation after conservative surgery for patients aged less than 60 years: a multi-centre comparative study

Cited by 10 publications

References 31 publications

Moderately hypofractionated post-operative radiation therapy for breast cancer: Systematic review and meta-analysis of randomized clinical trials

Moderately hypofractionated post-operative radiation therapy for breast cancer: Systematic review and meta-analysis of randomized clinical trials

Factors Associated with Late Local Radiation Toxicity after Post-Operative Breast Irradiation

Radiodermatitis and Fibrosis in the Context of Breast Radiation Therapy: A Critical Review

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