Clinical observation of short-term efficacies of different hypofractionated radiation therapies after modified radical mastectomy for breast cancer

The aims of this study were to analyze the acute and advanced responses of different hypofractionated radiation therapies (HFRT) after modified radical mastectomy for breast cancer (MRM-BC). A total of 162 patients were included into this prospective clinical Stage I-II study from October 2010 to May 2015, including 77 cases (group 42.5 Gy) and 85 cases (group 36.5 Gy). The acute and advanced side effects were analyzed according to static intensity modulation plan and Radiation Therapy Oncology Group (RTOG) classification criteria. There was no significant difference in the white blood cell reactions, acute skin reactions, and acute pharyngeal - esophageal reactions between group 42.5 Gy and 36.5 Gy, and no late complication was observed during follow-up. The median follow-up time of group 42.5Gy was 36 months and that of group 36.5 Gy was 12 months. There was no statistical significance in the local recurrencefree survival rate, disease-free survival rate, and distant metastasis rate between the two groups. There was no local recurrence or death in both groups (with the radiation field), and the local recurrence-free survival and overall survival rates of the two groups were both 100%. The incidence of acute adverse reactions and short-term efficacies of the two post-MRM-BC HFRT (42.5 Gy/16 F and 36.5 Gy/10 F) were similar, but the advanced adverse reactions and efficacies still need further observation.

Breast cancer; Modified radical mastectomy; Hypofractionated radiation therapy; Survival analysis.

[1] Siegel R., Ward E., Brawley O., Jemal A.: “Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths”. CA. Cancer J. Clin., 2011, 61, 212.

[2] Struikmans H., Aarts M.J., Jobsen J.J., Koning C.C., Merkus J.W., Lybeert M.L., et al.: “An increased utilisation rate and better compliance to guidelines for primary radiotherapy for breast cancer from 1997 till 2008: a population-based study in the Netherlands”. Radiother. Oncol., 2011, 100, 320.

[3] Sanpaolo P., Barbieri V., Genovesi D., Fusco V., Ausili Cèfaro G.: “Biologically effective dose and breast cancer conservative treatment: is duration of radiation therapy really important?” Breast Cancer Res. Treat., 2012, 134, 81.

[4] Jagsi R., Falchook A.D., Hendrix L.H., Curry H., Chen R.C.: “Adoption of hypofractionated radiation therapy for breast cancer after publication of randomized trials”. Int. J. Radiat. Oncol. Biol. Phys., 2014, 90, 1001.

[5] Kocher M., Wilms M., Makoski H.B., Hassler W., Maarouf M., Treuer H., et al.: “Alpha/beta ratio for arteriovenous malformations estimated from obliteration rates after fractionated and single-dose irradiation”. Radiother. Oncol., 2004, 71, 109.

[6] Hennequin C., Dubray B.: “Alpha/beta ratio revisited in the era of hypofractionation”. Cancer Radiother., 2013, 17, 344.

[7] Schneider U., Sumila M., Robotka J., Gruber G., Mack A., Besserer J.: “Dose-response relationship for breast cancer induction at radiotherapy dose”. Radiat. Oncol., 2011, 6, 67.

[8] International Prescribing: “Recording and Reporting Photon Beam Therapy (Supp lement to ICRU Report 50)”. ICRU Publications, 1999, 5.

[9] Commission on Radiation Units and Measurements (ICRU): “Reports 62”. ICRU Publications, 1999, 1097.

[10] Vargo J.A., Beriwal S.: “RTOG Chest Wall Contouring Guidelines for Post- Mastectomy Radiation Therapy: Is It Evidence-Based”. Int. J. Radiat. Oncol. Biol. Phys., 2015, 93, 266.

[11] Montero A., Sanz X., Hernanz R., Cabrera D., Arenas M., Bayo E., et al.: “Accelerated hypofractionated breast radiotherapy: FAQs (frequently asked questions) and facts”. Breast, 2014, 23, 299.

[12] Bantema-Joppe E.J., Vredeveld E.J., de Bock G.H., Busz D.M., Woltman-van Iersel M., Dolsma W.V., et al.: “Five year outcomes of hypofractionated simultaneous integrated boost irradiation in breast conserving therapy; patterns of recurrence”. Radiother. Oncol., 2013, 108, 269.

[13] Guerrero M., Li X.A.: “Analysis of a large number of clinical studies for breast cancer radiotherapy: estimation of radiobiological parameters for treatment planning”. Phys. Med. Biol., 2003, 48, 3307.

[14] Lalani N., Paszat L., Sutradhar R., Thiruchelvam D., Nofech-Mozes S., Hanna W., et al.: “Long-term outcomes of hypofractionation versus conventional radiation therapy after breast-conserving surgery for ductal carcinoma in situ of the breast”. Int. J. Radiat. Oncol. Biol. Phys., 2014, 90, 1017.

[15] Théberge V., Whelan T., Shaitelman S.F., Vicini F.A.: “Altered fractionation: rationale and justification for whole and partial breast hypofractionated radiotherapy”. Semin. Radiat. Oncol., 2011, 21, 55.

[16] Chan E.K., Woods R., McBride M.L., Virani S., Nichol A., Speers C., et al.: “Adjuvant hypofractionated versus conventional whole breast radiation therapy for early-stage breast cancer: long-term hospital- related morbidity from cardiac causes”. Int. J. Radiat. Oncol. Biol. Phys., 2014, 88, 786.

[17] Fong A., Shafiq J., Saunders C., Thompson A., Tyldesley S., Olivotto I.A., et al.: “A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of “optimal” therapy”. The Breast, 2012, 21, 562.

[18] START Trialists’ Group, Bentzen S.M., Agrawal R.K., Aird E.G., Barrett J.M., Barrett-Lee P.J., et al.: “The UK Standardisation of Breast Radiotherapy (START) Trial A of radio-therapy hypofractionation for treatment of early breast cancer: a randomised trial”. Lancet, 2008, 371, 1098.

[19] Pinnarò P., Soriani A., Landoni V., Giordano C., Papale M., Marsella A., et al.: “Accelerated hypofractionated radiotherapy as adjuvant redimen after conserving surgery for early breast cancer: Interim report of toxicity after a minimum follow up of 3 years”. J. Exp. Cin. Cancer Res., 2010, 29, 9.

[20] James M.L., Dehn G., Robinson B.A.: “Hypofractionated radiation treatment in early breast cancer: Results in a New Zealand setting”. Asia Pac. J. Clin. Oncol., 2016, 12, 248.

[21] Haviland J.S., Owen J.R., Dewar J.A., Agrawal R.K., Barrett J., Barrett- Lee P.J., et al.: “The UK standardisation of breast radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomized controlled trials”. Lancet Oncol., 2013, 14, 1086.

[22] Hopwood P., Haviland J.S., Sumo G., Mills J., Bliss J.M., Yarnold J.R.: “Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials”. Lancet Oncol., 2010, 11, 231.

[23] Min C., Connolly E., Chen T., Jozsef G., Formenti S.C.: “Hypofractionated radiation therapy for early stage breast cancer: outcomes, toxicities, and cost analysis”. Breast J., 2014, 20, 267.

[24] Whelan T.J., Pignol J.P., Levine M.N., Julian J.A., MacKenzie R., Parpia S., et al.: “Long-Term Results of Hypofractionated Radiation Therapy for Breast Cancer”. N. Engl. J. Med., 2010, 362, 513.

[25] Ciammella P., Podgornii A., Galeandro M., Micera R., Ramundo D., Palmieri T., et al.: “Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors”. Radiat. Oncol., 2014, 9, 97.

[26] Ko D.H., Norriss A., Harrington C.R., Robinson B.A., James M.L.: “Hypofractionated radiation treatment following mastectomy in early breast cancer: the Christchurch experience”. J. Med. Imaging. Radiat. Oncol., 2015, 59, 243.

[27] Budach W., Bölke E., Matuschek C.: “Hypofractionated Radiotherapy as Adjuvant Treatment in Early Breast Cancer. A Review and Meta-Analysis of Randomized Controlled Trials”. Breast Care (Basel), 2015, 10, 240.

[28] Bonin K., McGuffin M., Presutti R., Harth T., Mesci A., Feldman Stewart D., et al.: “Breast Cancer Patients’ Preferences for Adjuvant Radiotherapy Post Lumpectomy: Whole Breast Irradiation vs. Partial Breast Irradiation-Single Institutional Study.” J. Cancer Educ., 2018, 33, 37.

[29] Khan A.J., Ahlawat S., Goyal S.: “Novel and Highly Compressed Schedules for the Treatment of Breast Cancer”. Semin. Radiat. Oncol., 2016, 26, 45.

[30] Tiberi D., Hijal T., Yassa M.: “Current status of hypofractionated external beam radiotherapy for early-stage breast cancer”. Cancer Radiother., 2015, 19, 426.

[31] Qiu J.J., Chang Z., Horton J.K., Wu Q.R., Yoo S., Yin F.F.: “Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI)”. Med. Dosim., 2014, 39, 152.

[32] Michalski A., Atyeo J., Cox J., Rinks M., Morgia M., Lamoury G.: “A dosimetric comparison of 3D-CRT, IMRT, and static tomotherapy with an SIB for large and small breast volumes”. Med. Dosim., 2014, 39, 163.

[33] Feng Z., Wu H., Zhang Y., Zhang Y., Cheng J., Su X.: “Dosimetric comparison between jaw tracking and static jaw techniques in intensity- modulated radiotherapy”. Radiat. Oncol., 2015, 10, 28.

[34] Dai X., Zhao Y., Liang Z., Dassarath M., Wang L., Jin L., et al.: “Volumetric-modulated arc therapy for oropharyngeal carcinoma: a dosimetric and delivery efficiency comparison with static-field IMRT”. Phys. Med., 2015, 31, 54.

[35] Yang J.F., Lee M.S., Lin C.S., Chao H.L., Chen C.M., Lo C.H., et al.: “Long-Term Breast Cancer Patient Outcomes After Adjuvant Radiotherapy Using Intensity-Modulated Radiotherapy or Conventional Tangential Radiotherapy”. Medicine (Baltimore), 2016, 95, e3113.