Hypofractionated radiotherapy can potentially save resources thereby permitting more optimal utilization of the same in addition to enhanced convenience and less toxicity. Randomized trials have mostly focused on patients with early stage disease treated with breast conserving surgery (BCS). We hereby report our initial experience with hypofractionated radiation in an unselected group of patients who received post BCS or post mastectomy RT to local and regional nodal sites.
Patients who received hypofractionated RT to the breast or chest wall with or without regional nodal irradiation were reviewed. Period of study was between January 2013 and December 2014. Radiation dose given was 40 Gy@2.67 Gy/fraction, 15 fractions over three weeks on a Linac with 3DCRT. Tumor bed boost of 10 Gy over 5 fractions was given in BCS patients. Supraclavicular irradiation was given in node positive patients with the same dose.
65 patients were treated of which 61 were available for analysis. Median age was 51 years. 22 (36%) underwent BCS and 39 (64%) had mastectomy. Axillary dissection was done in 90% and 85% cases received chemotherapy. 5(8%), 26 (43%) and 30 (49%) cases had stage I, II and III disease respectively. Regional nodes were irradiated in 40 patients. Mean ipsilateral lung V20 was 31% and mean cardiac dose in left sided patients was 8.4 Gy. Dermatitis was grade 1 (60%) or grade 2 (39.5%) in all but one patient who had grade 3 dermatitis. In our historical series of patients treated with conventional fractionation 50 Gy, 25 fractions, 26% had grade 3 dermatitis. Grade 1 and 2 odynophagia was seen in 36% and 17.5% cases who received supraclavicular irradiation. In comparison with historical controls, toxicity was lower and there we no treatment interruptions. 2-year DFS and OS were 93% and 90% respectively.
Hypofractionated radiotherapy was well tolerated with lower toxicity compared to conventional RT. The reduced treatment time and toxicity can potentially improve patient compliance and satisfaction. This can translate into significant cost-effectiveness especially in resource-constrained settings.
Clinical trial identification
All authors have declared no conflicts of interest.