Early and Late Effects in Hypo Fractionation Versus Conventional Fractionation Radiotherapy in Early Breast Cancer
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- Category: Vol. 77, June 2009
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Early and Late Effects in Hypo Fractionation Versus Conventional Fractionation Radiotherapy in Early Breast Cancer,MAHA M. ABDULLAH, ASHRAF SHOMA and AMANY ALBASMY
Abstract
Objective: To evaluate acute morbidity, radiation dermatitis and pneumonitis, of Patients treated with whole breast hypo fractionated radiotherapy (RT) after breast-conserving Surgery (BCS), compared to conventional RT and to confirm the equivalence in terms of late effects between two the fraction-ation schedules of radiotherapy.
Methods: Sixty patients with T1-3a breast cancer who underwent breast conserving surgery (BCS) were included in the study. Half of the patients received whole breast irradiation, consisting of 50 Gy/25f/5w+boost 10Gy/5f/1w to tumor bed (group A). The other half received 45Gy/15f/5weeks +boost 10Gy/5f/1w to tumor bed (group B). The two groups were comparable otherwise. Early skin reaction were graded ac-cording to the Common Terminology Criteria for Adverse Events version 3.0 by the investigators and late cosmetic results were evaluated with the SOMA-LENT scoring system.
A comparison was done between the incidence of these reactions and different variables as: total radiation dose, number of surgically dissected nodes. etc.
The majority of patients (64.1%) had grade 0 /II radiation reaction and 35.9% had grade III/IV reaction. On uni-variate analysis, there was no statistically significant difference between the two radiation arms regarding the incidence of radiation reaction.
In conventional group (13%) (Grade 0). Moreover, 15 (50%), 5 (17%) and (20%) had Grade I, II and III radiation dermatitis, respectively. With the hypo fractionated RT. Fur-thermore, 8 (60%), 5 (17%) and 4 (13%) had Grade I, II and III radiation dermatitis, respectively. Regarding radiation pneumonitis) (6%) of conventional fractionation group had Grade I radiation pneumonitis. 5 (17%) had grade II. Pneu-monitis graded III or more was not observed. No patient treated with the hypo fractionated schedule had symptomatic radiation pneumonitis In SOMALENT scoring system Pain. In 3 (9%) and (6%) of both groups respectively had grade2- 3. No grade 4 pain was reported. (6%) of group A and (9%) of group B had grade 2 breast edema. No patient of either group had grade 3-4 breast edema. (17%) and (27%) had grade 1-2 and grade 2 fibrosis in group A and B, respectively. Telangiectasia grade 2 and grade 1-2 were reported in (6%) of both groups A and B, respectively. (17%) in group A had
grade 2 and grade 3 arm edema, respectively. In-group B only 2 patients had grade 2, one patient had atrophy in group 1 while no cases were seen in conventional group and no skin ulceration was seen in either groups.
Conclusions: Preliminary results showed that Radiation dermatitis and pneumonitis in patients treated with the Hypo fractionated schedule is acceptable. Especially, radiation dermatitis by the hypo fractionated.
Schedule is milder than that by the conventional schedule and that supports the use of a shorter fractionation schedule of 45Gy/15f/5w plus boost in patients with breast conserving surgery. The study is still going on to study the late effects on a larger number of patients for final evaluation of this regimen.