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Ten-year outcomes of 3D-conformal accelerated partial vs. whole breast irradiation after breast-conserving surgery: A
Budhi Singh Yadav1, Sofia Loganathan2, Divya Dahiya3
1Department of Radiotherapy & Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education & Research, Sector-12, Chandigarh, India.
Background:
To compare long term clinical outcomes after accelerated partial breast irradiation (APBI) versus whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy in women with breast cancer after breast conservation surgery (BCS).
Materials And Methods:
Women >35 years of age with invasive or noninvasive breast cancer ≤4 cm treated by BCS were randomized to 3D-CRT APBI (34 Gy/10 fractions/5 days) or WBI (40 Gy/16 fractions/3 weeks ± boost irradiation). The primary outcome was ipsilateral breast tumor recurrence. Important secondary outcomes were late toxicities using Radiation Therapy Oncology Group scores, Late Effects Normal Tissue Task Force and Subjective, Objective, Management, Analytic scales, adverse cosmetic outcome and distant metastases. The secondary endpoints of radiation toxicities and cosmesis were published in an interim analysis. Here we present the primary outcome and the late toxicities data. Patient and tumor characteristics, local recurrence and rates of adverse cosmetic outcomes were compared using Fisher exact tests. Locoregional recurrence free survival (LRRFS), disease free survival (DFS) and overall survival (OS) was calculated using Kaplan-Meier curves. All statistical tests were 2 sided, with p < 0.05 considered statistically significant.
Results:
Between June 2011 and December 2015, 132 women with breast cancer were randomized to 3D-CRT APBI or WBI. Patient and tumor characteristics were balanced between the two arms. Median follow-up was 10.8 years (range, 3.2-13.6 years). Local recurrence was observed in 3 (4.6 %) and 2 (3 %) patients in APBI and WBI arms (p = 0.62), respectively. Distant metastases occurred in 5 (7.6 %) and 3 (4.4 %) patients in APBI and WBI arms (p = 0.35), respectively. The HR for locoregional recurrence was 1.62 (95 % CI, 0.27-9.67, p = 0.60) for APBI (65 patients, 3 local recurrences) vs. WBI (67 patients, 2 local recurrences). The 10-year LRRFS rates (95 % CIs) were 97 % (88-99 %) and 95 % (86-98 %), respectively. The HR for disease-recurrence (local or distant) was 1.47 (95 % CI, 0.51-4.25, p = 0.47) for APBI (65 patients, 8 recurrences) vs. WBI (67 patients, 6 recurrences). The 10-year DFS rates (95 % CIs) were 92 % (83-97 %) and 88 % (77-94 %), respectively. The HR for death was 1.14 (95 % CI, 0.23-5.67, p = 0.87) for APBI (65 patients, 3 deaths) vs. WBI (67 patients, 3 deaths). The 10-year OS rates (95 % CIs) were 97 % (87-99 %) and 95 % (85-98 %), respectively. Adverse cosmesis was significantly higher in patients treated with WBI: 18 (30 %) compared with 3 (5 %) with APBI (p < 0.001). Late arm edema was observed in 1 (1.5 %) patients in APBI arm as compared to 4 (6 %) in WBI arm (p = 0.72).
Conclusions:
In women with breast cancer after BCS, APBI was comparable to WBI in terms of LRRFS, DFS and OS. Cosmetic outcome was better in APBI arm. Late arm edema was also comparable between the two arms.
