Toxicity of Hypofractionated Whole Breast Radiotherapy Without Boost and Timescale of Late Skin Responses in a Large Cohort of Early-Stage Breast Cancer Patients

• Published in: Clinical breast cancer Vol. 22; no. 4; pp. e480 - e487
• Main Authors: Fodor, Andrei, Brombin, Chiara, Mangili, Paola, Tummineri, Roberta, Pasetti, Marcella, Zerbetto, Flavia, Longobardi, Barbara, Galvan, Ariadna Sanchez, Deantoni, Chiara Lucrezia, Dell'Oca, Italo, Castriconi, Roberta, Esposito, Pier Giorgio, Deli, Aniko Maria, Rancoita, Paola Maria Vittoria, Fiorino, Claudio, Vecchio, Antonella Del, Di Serio, Mariaclelia Stefania, Di Muzio, Nadia Gisella
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2022
• Subjects: Breast radiotherapy boost; Hypofractionated whole-breast radiotherapy; Radiotherapy in conservative breast cancer treatment; Toxicity of breast cancer radiotherapy; Hypofractionated whole-breast radiotherapy; Radiotherapy in conservative breast cancer treatment; Breast radiotherapy boost; Toxicity of breast cancer radiotherapy
• ISSN: 1526-8209; 1938-0666
• DOI: 10.1016/j.clbc.2021.11.008

To report toxicity of hypofractionated whole-breast radiotherapy in a large cohort of early-stage breast cancer (BCaients. From 02/2009-05/2017, 1325 consecutive BCa patients were treated with 40.05 Gy/15 fractions, without boost. Median age was 62 (IQR:51.1-70.5) years. Chemotherapy was prescribed for 28% of patients, hormonal therapy for 80.3%, monoclonal antibodies for 8.2%. Median follow-up was 72.4 (IQR: 44.6-104.1) months. Acute RTOG toxicity was: 69.8% Grade (G) 1, 14.3% G2 and 1.7% G3. Late SOMA-LENT toxicities were: edema-hyperpigmentation (E-H): G1 28.67%, G2 4.41%, G3 0.15%; fibrosis-atrophy-telangiectasia-pain (F-A-T-P): G1 14.6%, G2 3.2%, G3 0.8%, G4 0.1%. Median time to first occurrence was 6 and 18 months, respectively. Aesthetic result after surgery was excellent in 28.7%, good in 41.5%, acceptable in 20.3% and poor in 9.5% of patients. Change in breast appearance after radiotherapy was mild in 6.9%, moderate in 2.3% and marked in 1.3% of patients. Concomitant chemotherapy, obesity, smoking, use of bolus and planning target volume (PTV) were associated with higher acute toxicity. Patients ≥55 years old were less likely to experience acute toxicity. PTV and acute G2 toxicity were associated with ≥G2 E-H. PTV, concomitant chemotherapy, hypertension and ≥G2 acute toxicity were associated with increased risk of F-A-T-P. Hypofractionated whole-breast radiotherapy without boost demonstrated mild acute and late toxicity in a large cohort of consecutive patients. Moderate and marked changes in breast appearance were registered for 3.6% of patients and occurred between 18 to 42 months. In this study the evolution over time of skin toxicity after early-stage breast cancer hypofractionated irradiation was analyzed. In a large cohort of 1325 consecutive patients, it was observed that the median time to first occurrence of edema-hyperpigmentation was 6 months, while for fibrosis-atrophy-telangiectasia-pain it was 18 months. Marked changes in the breast appearance occurred between 18 and 42 months.