294P - Hypofractionated radiotherapy reduces acute skin toxicity in small and large breasted patients receiving whole-breast irradiation

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Complications/Toxicities of Treatment
Surgical Oncology
Breast Cancer
Radiation Oncology
Presenter Liv Veldeman
Citation Annals of Oncology (2014) 25 (suppl_4): iv85-iv109. 10.1093/annonc/mdu327
Authors L. Veldeman1, S. De Langhe1, V. Remouchamps2, A. van Greveling1, M. Gilsoul2, B. Speleers1, W. De Neve1, R. van den Broecke3, T. Mulliez1
  • 1Radiation Oncology, Ghent University Hospital, 9000 - Gent/BE
  • 2Radiation Oncology, Clinique Ste Elisabeth, Namur/BE
  • 3Gynaecology, Ghent University Hospital, 9000 - Gent/BE



Despite the results of large randomized trials in the UK and Canada showing that hypofractionation (HF) radiotherapy is at least as favorable as normofractionation (NF) schemes for whole-breast irradiation (WBI) in terms of loco-regional control and cosmetic outcome, some radiation oncologists are reluctant to use HF WBI fearing increased toxicity, especially in large breasted patients. In this study the effect of the fractionation schedule on acute toxicity was investigated in a cohort of 229 breast cancer patients with various cup sizes treated with WBI in 2 different radiotherapy centers.


From May 2010 till December 2012, 150 patients from Ghent University Hospital (GUH) and 79 patients from Clinique et Maternité Sainte-Elisabeth Namur (CMSE) were included in a prospective study aiming at developing a prediction model for radiation-related breast toxicity using clinical, dosimetric and genetic parameters. All patients at GUH were treated with a HF scheme of 40,05 Gy in 15 fractions. At CMSE patients with a cup size D or more were treated with NF WBI (50 Gy in 25 fractions), while patients with a cup size < D were treated with NF or HF at the discretion of the responsible radiation oncologist. The primary endpoint was acute moist desquamation.


Patients with a cup size < D developed significantly more moist desquamation when treated with NF compared to HF (39% vs 9.5%, respectively, p < 0.001). In patients with a cup size D or more the frequency of moist desquamation was 68% in the NF group compared to 20% in the HF group (p = 0.002). There was no difference in moist desquamation between GUH and CMSE for patients treated with HF (8% vs 5%, respectively).


HF whole-breast radiotherapy results in significantly less moist desquamation compared to NF regardless of cup size.


All authors have declared no conflicts of interest.