Abstract 18P
Background
Traditionally, Hypofractionated Radiotherapy (HFRT) is avoided for Regional Nodal Irradiation (RNI) due to concerns about acute esophagitis. However, IMRT allows for specific dose restrictions to organs at risk. This study compares acute esophagitis and treatment breaks between conventional-fractionated (CF) and hypofractionated (HF) Breast and RNI.
Methods
This retrospective study involved 100 patients, with 50 in each arm (CF: Arm A, HF: Arm B), from treatment records post institutional ethical clearance. Eligible patients were ≥18 years, receiving external beam radiotherapy (EBRT) to the chest wall/breast and RNI post BCS/mastectomy. Those receiving only breast/chest wall irradiation were excluded. Patients received either CFRT (50 Gy in 25 fractions) or HFRT (40 Gy in 15 fractions) with a boost if necessary. Total dose, dose per fraction and mean esophageal dose were compared. RE was evaluated weekly using RTOG grading criteria. Data on treatment breaks were collected.
Results
Each arm had 50 patients. The median age in Arm A was 50-60 (mean: 55) and in Arm B 40-50 (mean: 47). Stage distribution (I-IV) was 0, 15, 28, 7 in Arm A and 3, 29, 14, 4 in Arm B. Luminal subtype distribution (Luminal A, Luminal B, Her2neu enriched, TNBC) was 2, 24, 16, 8 in Arm A & 3, 18, 10, 19 in Arm B. Nodal involvement (N2, N3) was 24 & 28 in Arm A, and 22 & 32 in Arm B. Acute esophageal toxicities (grades I, II, III, IV) were 7, 43, 0, 0 in Arm A and 10, 40, 0, 0 in Arm B. The average mean esophageal dose was 15.2 Gy in Arm A and 13.68 Gy in Arm B. No treatment breaks (>3 days) were observed in either group. Statistically no significant difference in grade III/IV acute esophagitis between groups, with grade II esophagitis also statistically insignificant (p < 0.5).
Conclusions
For RNI, particularly SCF irradiation, using a neck tilt maneuver can minimize esophageal radiation exposure and reduce acute esophagitis risk. Our study shows that with IMRT, the incidence of acute esophagitis does not significantly differ between CF and HF breast and RNI groups when mean esophageal dose constraints are respected.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
S.S. Gopireddy: Financial Interests, Personal, Full or part-time Employment: HCG HealthCare Global Enterprises Ltd.