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Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer

Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer
Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer
Aims

A pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer.

Materials and methods

Thirty women with early invasive breast cancer aged ?50 years with a pathological tumour size <3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6–10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0 = none, 1 = mild, 2 = moderate, 3 = severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years.

Results

Nine patients (30%, 95% confidence interval 14.7–49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95% confidence interval 3.7–30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95% confidence interval 9.9–42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1–3.9 years) there have been no ipsilateral local tumour relapses.

Conclusions

Further evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days.
breast cancer, fractionation, hypofractionation, radiotherapy
0936-6555
502-505
Martin, S.
e6903c26-e75e-4f74-bd6e-a468d7ff65f0
Mannino, M.
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Rostom, A.
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Tait, D.
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Donovan, E.
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Eagle, S.
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Haviland, J.S.
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Yarnold, J.
0003b4fd-a371-4258-890f-ffd3d0b5c3a9
Martin, S.
e6903c26-e75e-4f74-bd6e-a468d7ff65f0
Mannino, M.
7adcbba7-d763-40cb-ab08-aa44e968cf65
Rostom, A.
6fba23ff-5123-43df-b92b-7fb5306324f8
Tait, D.
488f9d62-f8a8-44d0-bb6c-7fb6f0668b15
Donovan, E.
f10e198f-0476-4a3f-87a8-46335881db20
Eagle, S.
5db85e35-d842-45d0-b024-0989745afd7c
Haviland, J.S.
569aa43b-15bd-4e9d-b4a5-e68a84334cfe
Yarnold, J.
0003b4fd-a371-4258-890f-ffd3d0b5c3a9

Martin, S., Mannino, M., Rostom, A., Tait, D., Donovan, E., Eagle, S., Haviland, J.S. and Yarnold, J. (2008) Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer. Clinical Oncology, 20 (7), 502-505. (doi:10.1016/j.clon.2008.04.020).

Record type: Article

Abstract

Aims

A pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer.

Materials and methods

Thirty women with early invasive breast cancer aged ?50 years with a pathological tumour size <3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6–10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0 = none, 1 = mild, 2 = moderate, 3 = severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years.

Results

Nine patients (30%, 95% confidence interval 14.7–49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95% confidence interval 3.7–30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95% confidence interval 9.9–42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1–3.9 years) there have been no ipsilateral local tumour relapses.

Conclusions

Further evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days.

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More information

e-pub ahead of print date: 16 June 2008
Published date: September 2008
Keywords: breast cancer, fractionation, hypofractionation, radiotherapy
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 365570
URI: http://eprints.soton.ac.uk/id/eprint/365570
ISSN: 0936-6555
PURE UUID: 5f0e9fbf-73a1-45e2-9785-b602d21822c0

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Date deposited: 11 Jun 2014 10:27
Last modified: 14 Mar 2024 16:58

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Contributors

Author: S. Martin
Author: M. Mannino
Author: A. Rostom
Author: D. Tait
Author: E. Donovan
Author: S. Eagle
Author: J.S. Haviland
Author: J. Yarnold

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