Post mastectomy adjuvant radiotherapy in breast cancer: a comparision of three hypofractionated protocols

To compare three hypofractionated protocols in postmastectomy cancinoma breast in terms of local control, toxicity and work load.

A total of three hundred patients suffering from cancer breast stage T2-4, N any were randomized into three arms after mastectomy. All the patients were treated with four fields on Co60 i.e. two tangential portals for chest wall, one anterior supraclavicular and axillary field and a posterior axillary boost and were randomized into three arms i.e. 2700 CGy in 5 fractions (one week) arm A, 3500 CGy in 10 fractions (2 weeks) arm B and 4000 CGy in 15 fractions (3 weeks) arm C. Skin, cardiac, pulmonary and haematological toxicities and lymphoedema were compared in addition to local control and work load.

The locoregional relapses were 11%, 12% and 10% in arms A, B and C respectively. 26%, 24% and 28% patients developed metastatic disease and 17%, 18% and 20% died in the three arms. G3 and G4 skin toxicities were 37%, 28% and 14%. G2 and G3 lymphedoema was 21%, 22% and 27%. Cardiac toxicity was 5%, 6% and 5% while pulmonary toxicity was 4%, 5% and 5% respectively. All the differences except skin toxicity were statistically insignificant. There were no cases of haematological depression or rib fractures.

All the three short protocols were equally effective in locoregional disease control and toxicity was also comparable. They were helpful in reducing the work load and can be safely recommended for routine clinical use.