Hypofractionated vs Conventionally Fractionated Postmastectomy Radiation After Implant-Based Reconstruction: A Randomized Clinical Trial.

Autor:	Wong JS; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts., Uno H; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Tramontano AC; Dana-Farber Cancer Institute, Boston, Massachusetts., Fisher L; Dana-Farber Cancer Institute, Boston, Massachusetts., Pellegrini CV; Dana-Farber Cancer Institute, Boston, Massachusetts., Abel GA; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Burstein HJ; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts., Chun YS; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts., King TA; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts., Schrag D; Memorial Sloan Kettering Cancer Center, New York, New York., Winer E; Yale Cancer Center, New Haven, Connecticut., Bellon JR; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts., Cheney MD; Maine Medical Center, Portland, Maine., Hardenbergh P; Vail Health, Vail, Colorado., Ho A; Duke University Medical Center, Durham, North Carolina., Horst KC; Stanford University School of Medicine, Stanford, California., Kim JN; Fred Hutchinson Cancer Center/UW Medicine, Seattle, Washington., Leonard KL; Warren Alpert Medical School of Brown University, Providence, Rhode Island.; Rhode Island Hospital, Providence., Moran MS; Yale Cancer Center, New Haven, Connecticut., Park CC; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California., Recht A; Harvard Medical School, Boston, Massachusetts.; Beth Israel Deaconess Medical Center, Boston, Massachusetts., Soto DE; Massachusetts General Hospital, Boston., Shiloh RY; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts., Stinson SF; Johns Hopkins School of Medicine, Baltimore, Maryland., Snyder KM; Northern Light Health, Brewer, Maine., Taghian AG; Harvard Medical School, Boston, Massachusetts.; Massachusetts General Hospital, Boston., Warren LE; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts., Wright JL; Johns Hopkins School of Medicine, Baltimore, Maryland., Punglia RS; Dana-Farber Cancer Institute, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts.; Brigham and Women's Hospital, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA oncology [JAMA Oncol] 2024 Oct 01; Vol. 10 (10), pp. 1370-1378.
DOI:	10.1001/jamaoncol.2024.2652
Abstrakt:	Importance: Postmastectomy radiation therapy (PMRT) improves local-regional disease control and patient survival. Hypofractionation (HF) regimens have comparable efficacy and complication rates with improved quality of life compared with conventional fractionation (CF) schedules. However, the use of HF after mastectomy in patients undergoing breast reconstruction has not been prospectively examined. Objective: To compare HF and CF PMRT outcomes after implant-based reconstruction. Design, Setting, and Participants: This randomized clinical trial assessed patients 18 years or older undergoing mastectomy and immediate expander or implant reconstruction for breast cancer (Tis, TX, or T1-3) and unilateral PMRT from March 8, 2018, to November 3, 2021 (median [range] follow-up, 40.4 [15.4-63.0] months), at 16 US cancer centers or hospitals. Analyses were conducted between September and December 2023. Interventions: Patients were randomized 1:1 to HF or CF PMRT. Chest wall doses were 4256 cGy for 16 fractions for HF and 5000 cGy for 25 fractions for CF. Chest wall toxic effects were defined as a grade 3 or higher adverse event. Main Outcomes and Measures: The primary outcome was the change in physical well-being (PWB) domain of the Functional Assessment of Cancer Therapy-Breast (FACT-B) quality-of-life assessment tool at 6 months after starting PMRT, controlling for age. Secondary outcomes included toxic effects and cancer recurrence. Results: Of 400 women (201 in the CF arm and 199 in the HF arm; median [range] age, 47 [23-79] years), 330 patients had PWB scores at baseline and at 6 months. There was no difference in the change in PWB between the study arms (estimate, 0.13; 95% CI, -0.86 to 1.11; P = .80), but there was a significant interaction between age group and study arm (P = .03 for interaction). Patients younger than 45 years had higher 6-month absolute PWB scores if treated with HF rather than CF regimens (23.6 [95% CI, 22.7-24.6] vs 22.0 [95% CI, 20.7-23.3]; P = .047) and reported being less bothered by adverse effects (mean [SD], 3.0 [0.9] in the HF arm and 2.6 [1.2] in the CF arm; P = .02) or nausea (mean [SD], 3.8 [0.4] in the HF arm and 3.6 [0.8] in the CF arm; P = .04). In the as-treated cohort, there were 23 distant (11 in the HF arm and 12 in the CF arm) and 2 local-regional (1 in the HF arm and 1 in the CF arm) recurrences. Chest wall toxic effects occurred in 39 patients (20 in the HF arm and 19 in the CF arm) at a median (IQR) of 7.2 (1.8-12.9) months. Fractionation was not associated with chest wall toxic effects on multivariate analysis (HF arm: hazard ratio, 1.02; 95% CI, 0.52-2.00; P = .95). Fewer patients undergoing HF vs CF regimens had a treatment break (5 [2.7%] vs 15 [7.7%]; P = .03) or required unpaid time off from work (17 [8.5%] vs 34 [16.9%]; P = .02). Conclusions and Relevance: In this randomized clinical trial, the HF regimen did not significantly improve change in PWB compared with the CF regimen. These data add to the increasing experience with HF PMRT in patients with implant-based reconstruction. Trial Registration: ClinicalTrials.gov Identifier: NCT03422003.
Databáze:	MEDLINE
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