Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
권호 표지
DOI QR코드

DOI QR Code

Hypofractionated Radiotherapy for Breast Cancers - Preliminary Results from a Tertiary Care Center in Eastern India

  • Published : 2014.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The standard radiotherapy (RT) fractionation practiced in India and worldwide is 50Gy in 25 fractions over 5 weeks to the chest wall or whole breast followed by tumour bed boost in case of breast conservation (BCS). A body of validated data exists regarding hypofractionation in breast cancer. We here report initial results for 135 patients treated at our center with the START-B type of fractionation. Materials and Methods: From May 2011 till July 2012, women with all stages of breast cancer (excluding metastatic), who had undergone BCS or mastectomy were planned for 40Gy in 15 fractions over 3weeks to chest wall/whole breast and supraclavicular fossa (where indicated) followed by tumour bed boost in BCS patients. Planning was done using Casebow's technique. The primary end point was to assess the acute toxicity and the cosmetic outcomes. Using cosmetic scales; patients were assessed during radiotherapy and at subsequent follow up visits with the radiation oncologist. Results: Of the 135 patients, 62 had undergone BCS and 73 mastectomy. Median age of the population was 52 years. Some 80% were T1&T2 tumours in BCS whereas most patients in mastectomy group were T3&T4 tumours (60%). 45% were node negative in BCS group whilst it was 23% in the mastectomy group. Average NPI scores were 3.9 and 4.9, respectively. Most frequently reported histopathology report was infiltrating ductal carcinoma (87%), grade III being most common (58%), and 69% were ER positive tumours, and 30% were Her 2 Neu positive. Triple negative tumours accounted for 13% and their mean age was young (43 yrs.) The maximum acute skin toxicity at the end of treatment was Grade 1 in 94% of the mastectomy grouppatients and 71% in BCS patients. Grade 2 toxicity was 6% in mast group and 23% in BCS group. Grade 3 was 6% in BCS group, no grade 3 toxicity in mastectomy patients and there was no grade 4 skin toxicity in any case. Post RT at 1 month; 39% of BCS patients had persisting Grade I skin reaction which was only 2% in mastectomy patients. At 3 months post RT, 18% patients had persisting hyperpigmentation. At 6 months 8% patients had persisting erythema in the BCS group only. Some 3% BCS and 8% mastectomy patients had lymph edema till the date of evaluation. Cosmetic outcome in BCS patients remained good to excellent 6 months post surgery and radiotherapy. 1 patient of BCS and 3 patients of mast had developed metastatic disease at the time of evaluation. Conclusions: Hypofractionated RT is well tolerated in Indian population with reduced acute skin toxicity and good cosmetic outcome. Regimens such as these should be encouraged in other centers to increase machine output time. The study is on-going to assess long term results.

Keywords

References

  1. Bartelink H, Horiot JC, Poortmans PM, et al (2007). Impact of a higher radiation dose on local control and survival in breastconserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 Trial, J Clin Oncol 25, 3259-65. https://doi.org/10.1200/JCO.2007.11.4991
  2. Casebow MP (1980). Angulation of radiotherapy treatment machines in a non-co-planar field technique. Br J Radiol, 53, 259-60. https://doi.org/10.1259/0007-1285-53-627-259
  3. Chakrabarti S, Karmakar R, Barui G, et al (2012), Prevalence of known prognostic factors in female breast carcinoma including oestrogen receptor, progesterone receptor and Her-2/neu status-a study in a tertiary care centre. J Indian Med Assoc, 110, 876-9.
  4. Deantonio L, Gambaro G, Beldi D, et al (2010). Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity. Radiat Oncol, 5, 11 https://doi.org/10.1186/1748-717X-5-11
  5. Early Breast Cancer Trialists' Collaborative Group (EBCTCG), (2011), Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. The Lancet, 378, 1707-16. https://doi.org/10.1016/S0140-6736(11)61629-2
  6. Faheem M, Mahmood H, Khurram M, Qasim U, Irfan J (2012). Estrogen receptor, progesterone receptor, and Her 2 Neu positivity and its association with tumour characteristics and menopausal status in a breast cancer cohort from northern Pakistan. Ecancer Medical Science, 6, 283.
  7. Gebski V, Lagleva M, Keech A, Simes J, Langlands AO (2006), Survival Effects of Postmastectomy Adjuvant Radiation Therapy Using Biologically Equivalent Doses: A Clinical Perspective, J Natl Cancer Inst, 98, 26-38. https://doi.org/10.1093/jnci/djj002
  8. GLOBOCAN 2012, http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx as accessed on 14/1/14
  9. GLOBOCAN 2008, http://www.iarc.fr/en/media-centre/iarcnews/2010/globocan2008.php as accessed on 17/11/13
  10. Haviland JS, Owen JR, Dewar JA, et al (2013). The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trial. Lancet Oncol, 14, 1086-94. https://doi.org/10.1016/S1470-2045(13)70386-3
  11. Hijal T, Al Hamad AA, Niazi T, et al (2010). Hypofractionated radiotherapy and adjuvant chemotherapy do not increase radiation-induced dermatitis in breast cancer patients. Curr Oncol, 17, 22-7.
  12. International Commission on Radiation Units and Measurements: Prescribing, recording and reporting photon beam therapy: ICRU report 50 Bethesda: International Commission on Radiation Units and Measurements. (1993).
  13. Manoharan N, Tyagi BB, Raina V (2010). Cancer incidences in rural Delhi-2004-05. Asian Pac J Cancer Prev. 11, 73-7.
  14. Mehrotra R, Pandya S, Singhla M, Srivastava D, Singh M, (2008). Spectrum of malignancies in Allahabad, North India: a hospital-based study. Asian Pac J Cancer Prev, 9, 525-8.
  15. Nandi M, Mandal A, Asthana AK (2013). Audit of cancer patients from Eastern Uttar Pradesh (UP), India: a university hospital based two year retrospective analysis. Asian Pac J Cancer Prev, 14, 4993-8. https://doi.org/10.7314/APJCP.2013.14.9.4993
  16. NCRP, Three Year Report of Population Based Cancer Registries 2009-2011, Bangalore , India, February 2013.
  17. Onitilo AA, Engel JM, Greenlee RT, Mukesh BN (2009). Breast cancer subtypes based on ER/PR and Her2 Expression: comparison of clinicopathologic features and survival. Clin Med Res, 7, 4-13 https://doi.org/10.3121/cmr.2008.825
  18. Pierce LJ (2005). The Use of Radiotherapy after Mastectomy: A Review of the Literature. J Clin Oncol, 23, 1706-17. https://doi.org/10.1200/JCO.2005.08.109
  19. Pinnaro P, Soriani A, Landoni V, et al (2010). Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years. J Exp Clin Cancer Res, 29, 9 https://doi.org/10.1186/1756-9966-29-9
  20. Roche H, Fumoleau P, Spielmann M, et al (2006). Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial, J Clin Oncol, 24, 5664-71. https://doi.org/10.1200/JCO.2006.07.3916
  21. Sen S, Gayen R, Das S, et al (2012). A clinical and pathological study of triple negative breast carcinoma: experience of a tertiary care centre in eastern India. J Indian Med Assoc, 110, 686-9, 705.
  22. Shetty P (2012). World Report, India faces growing breast cancer epidemic, Lancet, 379, 992-3 https://doi.org/10.1016/S0140-6736(12)60415-2
  23. Sofi GN, Sofi JN, Nadeem R, et al (2012), Estrogen receptor and progesterone receptor status in breast cancer in relation to age, histological grade, size of lesion and lymph node involvement, Asian Pac J Cancer Prev, 13, 5047-52 https://doi.org/10.7314/APJCP.2012.13.10.5047
  24. START Trialists' Group, Bentzen SM, Agrawal RK, et al (2008). The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 9, 331-41. https://doi.org/10.1016/S1470-2045(08)70077-9
  25. Swaminathan R, Selvakumaran R, Esmy PO, et al (2009). Cancer pattern and survival in a rural district in South India. Cancer Epidemiol, 33, 325-31. https://doi.org/10.1016/j.canep.2009.09.008
  26. Takiar R, Srivastav A (2008), Time trend in breast and cervix cancer of women in India-(1990-2003). Asian Pac J Cancer Prev, 9, 777-80.
  27. The START Trialists' Group (2008), The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial, Lancet, 371, 1098-110 https://doi.org/10.1016/S0140-6736(08)60348-7
  28. Whelan T, MacKenzie R, Julian J, et al (2002), Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst, 94, 1143-50 https://doi.org/10.1093/jnci/94.15.1143
  29. Whelan TJ, Pignol JP, Levine MN, et al (2010), Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer, N Engl J Med, 362, 513-20. https://doi.org/10.1056/NEJMoa0906260

Cited by

  1. Benefit of Post-mastectomy Radiotherapy of the Supra-/infraclavicular Lymphatic Drainage Area in Breast Cancer Patients vol.15, pp.14, 2014, https://doi.org/10.7314/APJCP.2014.15.14.5557
  2. Morphological Factors and Cardiac Doses in Whole Breast Radiation for Left-sided Breast Cancer vol.16, pp.7, 2015, https://doi.org/10.7314/APJCP.2015.16.7.2889
  3. Awareness and current knowledge of breast cancer vol.50, pp.1, 2017, https://doi.org/10.1186/s40659-017-0140-9