Retrospective analysis of efficacy and toxicity of hypo-fractionated radiotherapy in breast carcinoma

Abstract

The standard dose fractionation of Radiotherapy to whole breast is 45–50Gy in 1.8–2.0Gy fractions. Boost volume generally defined as the lumpectomy cavity plus a 1.5– 2-cm margin receieves another 10-16Gy boost prescribed for a total dose of 60–66Gy at the lumpectomy site.The dose to the regional nodes, when indicated, is in the range of 50Gy. Alternative dose fraction schedules used in various randomised trials have established the role of Hypofractionated Radiotherapy (HRT) in early breast cancer. HRT allows time and cost saving thus better patient compliance. However, there is a paucity of data for HRT in locally advanced cases. Aim: To study the toxicity and efficacy of Hypofractionated Radiotherapy (HRT) as compared to Conventional Radiotherapy (CRT) in breast cancer at our centre. Materials and Methods: A retrospective analysis of breast cancer patients treated between October 2012- September 2014 with adjuvant radiation therapy as CRT or HRT. The data of these patients was retrieved and analysed regarding demographic profile, stage at presentation, pathological type, extent of surgery, chemotherapy, efficacy and toxicity of HRT. The toxicity assessment was done as per RTOG toxicity criteria. The data were analysed using SPSS software version 20.0. Results: A total of 100 patients with carcinoma breast who received radiotherapy over two years were analysed. Age ranged from 18-90 years, mean 49.15 ± 12.7 years. Fifty-five patients were post-menopausal, predominant clinical feature was painless lump in the breast (98%). Early stage (Stage I and II) constituted 41%, locally advanced disease in 59%. Modified radical mastectomy was done in 75%, breast conserving surgery in 25%. A 56 patients received HRT and 44 were treated with CRT. The most common acute toxicity was skin grade I. An 18% patients in HRT arm and 30% patients in conventional arm developed grade II skin toxicity (p=0.23). Dysphagia grade I was seen in 10% cases in CRT arm and 12% in HRT arm. The median follow-up period was 11.3 months with 2 loco-regional failures in each arm. Conclusion: HRT seems to be equally efficacious and no more toxic than CRT in carcinoma breast even in unselected subgroup of patients.