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 |
| Externí odkaz: |
|