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A Comparison Between Sequential Conventional and Hypofractionated Boost Following Whole-Breast Radiotherapy: A

Jewel Rajan1, Rajeev Kr1, Preethi Sara George2

  • 1Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, IND.

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|November 13, 2023
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Summary

Hypofractionated boost radiotherapy (RT) shows similar outcomes to conventional RT for breast cancer patients, offering a feasible alternative. Further follow-up is needed for definitive conclusions on this breast conservation therapy approach.

Keywords:
acute skin toxicityboost doseboost rtbreast cancerhypofractionation

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Breast Cancer Treatment

Background:

  • Local relapses after breast conservation therapy often occur near the primary lesion.
  • Boost radiotherapy (RT) improves outcomes but increases risks of skin reactions and fibrosis.
  • Optimal boost RT dose and timing after hypofractionated whole-breast radiotherapy (WBRT) remain unclear.

Purpose of the Study:

  • To compare the outcomes of sequential hypofractionated boost RT versus conventional fractionated boost RT.
  • To assess the efficacy and toxicity of different boost radiotherapy schedules in breast cancer patients undergoing conservative treatment.

Main Methods:

  • Retrospective propensity score-matched analysis of 166 patients with stage I-III breast cancer.
  • Comparison of hypofractionated RT (8 Gy/3 fractions) versus conventional RT (10 Gy/5 fractions) as a sequential boost.
  • Propensity score matching incorporated clinical stage, tumor grade, tumor biology, and boost technique.

Main Results:

  • No statistically significant difference in locoregional recurrence-free survival (LRFS) or overall survival (OS) at two years.
  • Disease-free survival (DFS) at two years was similar (91.5% hypofractionated vs. 96.3% conventional), with no significant difference.
  • Patients with grade 3 tumors receiving hypofractionated boost showed a significantly increased risk of recurrence (DFS: 88.9% vs. 100%).
  • No difference in acute skin toxicity was observed between the groups.

Conclusions:

  • Hypofractionated boost RT (8 Gy/3 fractions) is a feasible alternative to conventional boost RT (10 Gy/5 fractions) following WBRT.
  • Similar LRFS, OS, DFS, and acute skin toxicity were observed in the interim analysis.
  • Longer follow-up is necessary to draw definitive conclusions, especially for patients with grade 3 tumors.