Hypofractionated irradiation in elderly patients with breast cancer after breast conserving surgery and mastectomy : Analysis of 205 cases

Autor: Bruno Cutuli, M. Doré, Patrice Cellier, Loïc Campion, Magali Le Blanc
Jazyk: angličtina
Předmět:
Lung Diseases
medicine.medical_treatment
Triple Negative Breast Neoplasms
law.invention
Radiotherapy
High-Energy
Breast cancer
Elderly
Randomized controlled trial
law
Antineoplastic Combined Chemotherapy Protocols
Breast-conserving surgery
Local recurrence
Medicine
Telangiectasia
Mastectomy
Aged
80 and over
Middle Aged
Combined Modality Therapy
Postmenopause
Oncology
Radiology Nuclear Medicine and imaging
Lymphatic Metastasis
Nottingham Prognostic Index
Female
Radiation Dose Hypofractionation
Radiology
medicine.symptom
Radiodermatitis
Cardiomyopathies
medicine.medical_specialty
Breast Neoplasms
Hypofractionated radiotherapy
Humans
Radiology
Nuclear Medicine and imaging
Telangiectasis
Nodal irradiation
Aged
Chemotherapy
Lymphatic Irradiation
Toxicity
business.industry
Research
medicine.disease
Fibrosis
Surgery
Radiation therapy
Radiotherapy
Adjuvant
Neoplasm Recurrence
Local
business
Zdroj: Radiation Oncology (London, England)
ISSN: 1748-717X
DOI: 10.1186/s13014-015-0448-y
Popis: Background Several randomized trials and meta-analyses confirmed a wide benefit of radiotherapy (RT), both after breast conserving surgery (BCS) and mastectomy. However, many elderly women don't receive RT. Hypofractionated (HF) RT allows « simplified » and more accessible treatments with equivalent results to classic RT in three large randomized trials. However, there are few available data on HF-RT for nodal irradiation, as well as for the boost. Methods We evaluated patients treated for IBC by HF-RT between 2004 and 2012 in two regional cancer centres. We used an original scheme delivering 45 Gy in 15 fractions three times a week, both after BCS or mastectomy, with or without nodal irradiation. After BCS, a 9 Gy boost in 3 fractions was delivered. Local, regional and distant recurrences were assessed, as well as acute and late cutaneous, cardiac or pulmonary toxicities. Results 205 patients were analysed, 116 after BCS (57 %) and 89 after mastectomy (43 %). Median age was 81 years (range: 52-91); 44 % had axillary nodal involvement (pN+). The Nottingham Prognostic Index (NPI) scored 0, 1, 2 and 3 in 10 %, 27 %, 44 % and 19 % of the cases. A nodal HF-RT was delivered in 65 patients (32 %) and boost in 98 patients (84 % of BCS) by 9 Gy/3 fr scheme. Fifty (24 %) patients underwent chemotherapy and 156 (75 %) hormonal treatment. With a 49-month median follow-up, 3/116 (2.6 %) patients and 4/89 (4.5 %) had local recurrence (LR) after BCS and mastectomy, respectively. The overall 5-year LR rate was 4.4 %. In univariate and multivariate analysis, LR risk factors were: high NPI (HR 5.46; p = 0.028), and triple negative tumour (HR 9.78; p = 0.006). Only 8 (4.5 %) patients had grade III skin toxicity; 29 (14 %) late fibrosis and 16 (8 %) telangiectasia. No pulmonary or cardiac toxicity was observed. Conclusion Our HF-RT scheme (with or without nodal irradiation) confirms in elderly patients the data from randomized trials, both after BCS or mastectomy. Toxicity seems very acceptable but requires a longer follow-up. A larger evaluation is still ongoing in several other centres in France.
Databáze: OpenAIRE
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