Seventeen years experience with accelerated radiotherapy for carcinoma of the breast

Between 1973 and 1989, one hundred and three women received accelerated radiotherapy to the breast. Fifteen of them had the treatment after local tumor removal; the rest had primary radiotherapy for inoperable cancer. Eleven patients were irradiated twice a day, 83 three times a day, and nine four times a day. The overall time was five days in 52 courses, 7-15 days in 49 courses, and two patients had a longer regime. Actuarial local tumor control was 34.6% at five, and 24.7% at ten years in the whole group, and 25.5% and 14.6%, respectively, in the patients with macroscopical disease. Crude local control in the latter patients was achieved in 24.4% after a five day course, 28.8% after 7 to 11 days course, and 50% after a time of 12 or more days. Crude local control after total dose of less than 40 Gy was 15.8%, after 40-45 Gy, 31.7%, after 45.1-50 Gy, 33.3%, and after more than 50 Gy, 100% (four patients). Sixty patients were evaluable for late damage at 18 months; twenty three of them developed moderate changes. Six suffered severe late damage such as skin leathering or necrosis: three of them were treated for recurrence after previous radiotherapy. The main factor influencing tumor control was not the overall treatment time, but the total dose.