The effect of breast volume on toxicity using hypofractionated regimens for early stage breast cancer for patients

Abstract

Purpose Hypofractionated radiation therapy (HFRT) remains underused, despite multiple randomized trials showing the equivalence of HFRT to conventional fractionated radiation therapy (CFRT). We sought to retrospectively review the relationship between breast volume and toxicity for HFRT versus CFRT. Methods and materials Data from 114 patients who received a diagnosis of early stage breast cancer and were treated with lumpectomy and whole breast radiation alone were reviewed. Breast cancer laterality, stage, grade, estrogen/progesterone receptor and human epidermal growth factor receptor 2 status, and systemic therapy use were recorded. Length of follow-up was calculated using the last day of radiation treatment and the date of the most recent follow-up. Results The median follow-up was 42 months. A total of 83 patients were treated with HFRT and 31 with CFRT. Rates of grade ≥2 skin toxicity were significantly higher in patients undergoing CFRT compared with HFRT (76% vs 28%; P < .0001). In a subset of patients with breast volume ≥1000 cm 3 , grade ≥2 skin toxicity trended higher for CFRT patients (73% vs 38%; P = .057). For posterior separation >25 cm, the percentage of patients with grade 2 skin toxicity was 43% for HFRT versus 57% for CFRT ( P = .67). The volume of breast tissue receiving >105% of the total prescription dose, including boost, was not significantly different for HFRT versus CFRT ( P = .70). Conclusions Use of HFRT resulted in lower acute skin toxicity rates compared with CFRT. Large breast size (volume ≥1000 cm 3 ) was associated with lower acute grade 2 toxicity with the use of HFRT despite achieving similar dosimetry compared with CFRT.

Risk Factors Related to Acute Radiation Dermatitis in Breast Cancer Patients After Radiotherapy: A Systematic Review and Meta-Analysis

“…A total of 85 articles were further excluded for the following reasons: review or meta-analysis, small sample study, risk factors that are rarely studied, conference abstracts, non-intended endings, study being repeated on the same population, and lack of available data. Finally, 38 studies were included in this meta-analysis, of which five studies were RCTs, nine studies were retrospective designs, and 24 studies were prospective design ( 10 – 12 , 14 – 17 , 23 – 53 ). Except for one study from the WanFang database ( 40 ), all other included studies were indexed in PubMed.…”

“…Therefore, exploring the risk factors of ARD is an important priority in preventing ARD and caring for patients with breast cancer undergoing RT. According to present research reports, the development or severity of ARD is affected by several risk factors, including patient-related factors (e.g., smoking, bra size, age, ethnic origin, coexisting diseases, hormonal status, tumor site, and genetic factors) and treatment factors (e.g., beam energy, total dose of radiation, treatment techniques, volume and fraction of radiation, chemotherapy, and tamoxifen therapy) (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). However, inconsistencies still exist between different radiotherapy centers worldwide.…”

Breast Calcification Relative to Radiation Dose Distribution 21 years after Radiation Therapy: A Case Report and an Argument Against Hypofractionation of Breast Patients

“…Modern technology permits modulation of multiple sloped surfaces of the breast and can optimize dose asymmetry with multiple applied strategies including energy and intensity modulation. Publications demonstrating favorable outcome have encouraged modern technology for treatment execution and it is assumed, quite fairly with short term data, that favorable outcome is driven in part by advanced technology (Whelan et al, 2010;Kim et al, 2016;Bekelman et al, 2014;Butler-Xu et al, 2018). These investigators point to cost as a motivation to compress treatments (Bekelman et al, 2014) and indicate that acute effects associated from therapy are ameliorated during hypofractionation due in part to the application of modern technology (Butler-Xu et al, 2018).…”

“…While we continue to refine our craft and publish favorable outcomes with compressed therapy for breast cancer patients, the clinical euphoria promoted by this approach may be short lived (Bekelman et al, 2014;Butler-Xu et al, 2018;Hemingway, 1995). This patient serves as an unambiguous reminder that our technology may not erase our mistakes of the past.…”

Breast Radiotherapy after Oncoplastic Surgery—A Multidisciplinary Approach

“…Oncoplastic breast surgery incorporates more optimal incision placement (often via mastopexy, circumareolar, or inframammary fold incisions) for superior cosmetic outcomes. Historically, breast reduction has also been performed for better tolerance of radiotherapy [ 8 , 9 ] however with modern breast radiotherapy techniques, recent publications suggest that breast size does not have any implication on late radiotherapy effects [ 10 , 11 ].…”