Significance of Hypofractionated Radiotherapy in Postoperative Irradiation for Breast Cancer: An Asian Multi-institutional Prospective Study

• Published in: Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 35; no. 7; pp. 463 - 471
• Main Authors: Okonogi, N., Kono, S., Karasawa, K., Banu, P.A., Xu, X., Erawati, D., Adylkhanov, T., Jang, W.I., E., Yadamsuren, Calaguas, M.J., Thephamongkhol, K., Dung, T.A., Ng, W.N.P., Kato, S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2023
• Subjects: Adjuvant radiotherapy; breast neoplasm; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; breast-conserving surgery; clinical trial; Female; Humans; hypofractionation; Mastectomy; Mastectomy, Segmental; Prospective Studies; Radiation Dose Hypofractionation; Radiotherapy, Adjuvant - adverse effects; clinical trial; Adjuvant radiotherapy; breast neoplasm; mastectomy; hypofractionation; breast-conserving surgery
• ISSN: 0936-6555; 1433-2981
• DOI: 10.1016/j.clon.2023.04.007

There is a need for the adequate distribution of healthcare resources in Southeast Asia. Many countries in the region have more patients with advanced breast cancer who are eligible for postmastectomy radiotherapy (PMRT). Therefore, it is critical that hypofractionated PMRT is effective in most of these patients. This study investigated the significance of postoperative hypofractionated radiotherapy in patients with breast cancer, including advanced breast cancer, in these countries. Eighteen facilities in 10 Asian countries participated in this prospective, interventional, single-arm study. The study included two independent regimens: hypofractionated whole-breast irradiation (WBI) for patients who had undergone breast-conserving surgery and hypofractionated PMRT for patients who had undergone total mastectomy at a dose of 43.2 Gy in 16 fractions. In the hypofractionated WBI group, patients with high-grade factors received additional 8.1 Gy boost irradiation sessions for the tumour bed in three fractions. Between February 2013 and October 2019, 227 and 222 patients were enrolled in the hypofractionated WBI and hypofractionated PMRT groups, respectively. The median follow-up periods in the hypofractionated WBI and hypofractionated PMRT groups were 61 and 60 months, respectively. The 5-year locoregional control rates were 98.9% (95% confidence interval 97.4–100.0) and 96.3% (95% confidence interval 93.2–99.4) in the hypofractionated WBI and hypofractionated PMRT groups, respectively. Regarding adverse events, grade 3 acute dermatitis was observed in 2.2% and 4.9% of patients in the hypofractionated WBI and hypofractionated PMRT groups, respectively. However, no other adverse events were observed. Although further follow-up is required, hypofractionated radiotherapy regimens for postoperative patients with breast cancer in East and Southeast Asian countries are effective and safe. In particular, the proven efficacy of hypofractionated PMRT indicates that more patients with advanced breast cancer can receive appropriate care in these countries. Hypofractionated WBI and hypofractionated PMRT are reasonable approaches that can contain cancer care costs in these countries. Long-term observation is required to validate our findings. •Hypofractionated radiotherapy has not been thoroughly studied in Asia.•We examined the significance of hypofractionated radiotherapy for breast cancer patients in Asia.•227 hypofractionated whole breast and 222 hypofractionated postmastectomy radiotherapy patients were assessed prospectively.•The hypofractionated radiotherapy regimens for these patients were found to be effective and safe.