Treatment outcome of hypofractionated radiotherapy in post mastectomy breast cancer in Ubonratchathani cancer hospital
Keywords:
disease free survival, hypofractionated radiotherapy, locoregional recurrence, overall survival, postmastectomy radiotherapyAbstract
Background: Hypofractionated radiotherapy has been used in breast-conservative surgery. However, information regarding its application in the adjuvant setting after mastectomy in breast cancer patients is still under long-term studies to determine its effectiveness and potential side effects.
Objectives: This study aimed to assess the efficacy of post-mastectomy hypofractionated radiotherapy as regards 5-year locoregional recurrence-free survival (LRRFS), 5-year disease-free survival (DFS) and 5-year overall survival (OS) compared with conventional fractionated radiotherapy
Materials & methods: We retrospectively reviewed the record of post-mastectomy breast cancer patients who received complete adjuvant radiotherapy at Ubonratchatani Cancer Hospital between January 2016 and December 2020. Kaplan-Meier and Log-rank test were used for survival analysis. Cox regression was used for univariate and multivariate analysis to identify the prognostic factors. P-value < 0.05 was considered statistically significant.
Results: The median follow-up time was 46.5 months (range 24-61 months). A total of 552 post-mastectomy breast cancer patients who underwent complete adjuvant radiotherapy were included. Among them, 361 patients received conventional fractionated radiotherapy (CFRT) 50 Gy in 25 Fractions while 191 received hypofractionated radiotherapy (HFRT) 40-42.56 Gy in 15-16 fractions. There was no statistical difference between both groups regarding the 5-year LRRFS and 5-year DFS. The 5-year LRRFS rates for CFRT versus HFRT were 87.37 % and 86.60% (p-value = 0.642). The 5-year DFS rates for CFRT versus HFRT were 65.14% and 73.38% (p-value = 0.058). However, the 5-year OS rate was higher in HFRT group than CFRT group; 80.29% and 70.38%, respectively (p=0.015). Tumor stage and triple negative subtype were significant prognostic factors for locoregional recurrence and overall survival.
Conclusion: Post-mastectomy hypofractionated radiotherapy was comparably effective in terms of LRRFS and DFS with reduced overall treatment time and cost.
References
EBCTCG, McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet. 2014;383:2127-35.
Overgaard M, Nielsen HM, Tramm T, Hojris I, Grantzau TL, Alsner J, et al. Postmastectomy radiotherapy in high-risk breast cancer patients given adjuvant systemic therapy. A 30-year long-term report from the Danish breast cancer cooperative group DBCG 82bc trial. Radiother Oncol. 2022;170:4-13.
Qi XS, White J, Li XA. Is alpha/beta for breast cancer really low? Radiother Oncol. 2011;100:282-8.
Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, 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 randomised controlled trials. Lancet Oncol. 2013;14:1086-94.
Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362:513-20.
Wang SL, Fang H, Song YW, Wang WH, Hu C, Liu YP, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol. 2019;20:352-60.
Liu L, Yang Y, Guo Q, Ren B, Peng Q, Zou L, et al. Comparing hypofractionated to conventional fractionated radiotherapy in postmastectomy breast cancer: a meta-analysis and systematic review. Radiat Oncol. 2020;15:17.
Akl FMF, Khater A. Hypofractionated versus Conventionally Fractionated Radiotherapy in Post-Mastectomy Breast Cancer Patients. Journal of Cancer Therapy. 2018;09:941-54.
Chitapanarux I, Klunklin P, Pinitpatcharalert A, Sripan P, Tharavichitkul E, Nobnop W, et al. Conventional versus hypofractionated postmastectomy radiotherapy: a report on long-term outcomes and late toxicity. Radiat Oncol. 2019;14:175.
Tovanabutra C, Katanyoo K, Uber P, Chomprasert K, Sukauichai S. Comparison of Treatment Outcome between Hypofractionated Radiotherapy and Conventional Radiotherapy in Postmastectomy Breast Cancer. Asian Pac J Cancer Prev. 2020;21:119-25.
Greenbaum MP, Strom EA, Allen PK, Perkins GH, Oh JL, Tereffe W, et al. Low locoregional recurrence rates in patients treated after 2000 with doxorubicin based chemotherapy, modified radical mastectomy, and post-mastectomy radiation. Radiother Oncol. 2010;95:312-6.
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