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Accelerated hypofractionated whole-breast irradiation with concomitant daily boost in early breast cancer
George Kyrgias1, Anna Zygogianni, Kiki Theodorou
1Departments of *Radiotherapy §Medical Physics, School of Health Sciences, Faculty of Medicine, University of Thessaly †Department of Radiation Oncology, University Hospital of Larissa, Larissa, Thessaly ‡1st Department of Radiology-Radiotherapy Unit #2nd Department of Radiology-Radiotherapy Unit, School of Medicine, Kapodistrian University of Athens ¶2nd Department of Surgery, St Savvas Anticancer Hospital of Athens, Athens ∥Department of Radiotherapy-Oncology, Democritus University of Thrace-Medical School, Alexandroupolis, Greece.
Objectives:
The aim of this study is to evaluate the feasibility and the related toxicity of hypofractionated whole-breast irradiation with a concomitant daily boost in early breast cancer women not eligible for accelerated partial-breast irradiation.
Methods:
Twenty-seven patients received 46 Gy to the whole breast in 20 fractions/4 weeks with 2.3 Gy/fraction plus an additional concomitant daily boost of 0.4 Gy to the tumor bed, giving a total dose of 54 Gy (EQD2=60 Gy). The cosmetic outcome was assessed according to the European Organization for Research and Treatment of Cancer and Radiation Therapy Oncology Group grading system.
Results:
Three months after the end of radiotherapy, 59.2% and 40.7% of patients showed grade 0 skin toxicity and grade 1 skin toxicity, respectively. After 6 months, 70.4% and 29.6% of patients showed grade 0 and grade 1 skin toxicity. After 1 year, grade 0 skin toxicity was found in 77.7% of the patients and grade 1 skin toxicity in 22.2% of the patients. After 18 months, grade 0 skin toxicity was found in 92.6% and grade 1 skin toxicity in 7.4% of the patients. After a median follow-up of 24 months, all patients showed excellent cosmetic results with minimal breast edema and minimal skin changes. There have been no local relapses to date.
Conclusion:
The accelerated hypofractionated schedule with a concomitant boost appears to be an acceptable alternative to the traditional longer schedule, with low local toxicity and excellent to good short-term cosmetic results, although a much longer follow-up is needed to assess the local control rate.
