Phase 3 study comparing weekly concomitant boost for breast cancer patients treated with conservative breast surgery with sequential boost

Document Type : Original Article

Authors

1 Department of Clinical Oncology, Faculty of Medicine, Sohag University.

2 Department of Clincal Oncology and Nuclear Medicine, Faculty of Medicine, Sohag University.

3 Department of Clinical Oncology ,Faculty of Medicine, Sohag University.

Abstract

Background: Radiation therapy after breast conserving surgery is a standard part of treatment for invasive breast cancer. Based on radiobiological models, it was found that shorter hypofractiontaed radiation schedules had equivalent local control to standard radiation therapy. Radiation boost to the tumor bed was evident to be associated with significant improvement in local control.
Methods: This study included 48 female patients with early breast cancer who underwent breast conservative surgery. There were two arm of radiation, hypofractionated radiotherapy with concomitant boost (group A) - hypofractionated radiotherapy with sequential boost (group B).
Results: after median follow up 43 months range (21-57). Four year over all survival rate for concomitant boost arm was (91.67%) and sequential boost arm was (87.50%), Four year disease free survival rate for concomitant boost arm was (87.5%) and sequential boost arm was (79.17 %). late skin toxicity, grade 0 was (72.73%) in concomitant boost arm and (54.55%) in sequential boost arm and grade 1 was (9.09%) in concomitant boost arm and (31.82%) in sequential boost arm and grade 2 was (18.19) in concomitant boost arm and (13.55%) in sequential boost arm, grade 3 late lung toxicity was (4.17%) in concomitant boost arm and (12.50%) in sequential boost arm, cardiac toxicity in concomitant boost arm (8.33%) and sequential boost arm (16.67%).The ipsilateral lymphedema after 24 months of follow up G2 (4.55%) in concomitant boost arm G3 (4.55%) in in sequential boost arm.
Conclusion: A shortened whole breast irradiation schedule with a weekly concomitant boost may be an alternative option with acceptable toxicity and excellent cosmesis.

Main Subjects


1. Fisher B, Anderson S, Bryant J, et al: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plusirradiation for the treatment of invasive breast cancer. N Engl J Med. 2002; (347):1233–1241.
2. Cuzick J, Stewart H, Peto R, et al: Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet 2011; 378(9804): 1707–1716.
3. Clarke M, Collins R, Darby S, et al: Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366:2087–2106.
4. Whelan TJ, Pignol JP, LevineMN, et al: Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010; 362(6):513–
520.
5-Van der Laan HP, Dolsma WV, Maduro JH, Korevaar EW, Hollander M,Langendijk JA: Three-dimensional conformal simultaneously integratedboost technique for breast-conserving radiotherapy. Int J Radiat OncolBiol Phys 2007, 68(4):1018-23.
6-Guenzi M, Vagge S, AzinwN, et al: A biologically competitive 21 days hypofractionation scheme with weekly concomitant boost in breast cancer radiotherapy feasibility acute sub-acute and short term late effects Radiat Oncol. 2010; 5: 111
7-Corvo R, Ricchetti F, Doino D, et al:  Adjuvant hypo fractionated radiotherapy with weekly concomitant boost for women with early breast cancer: the clinical experience at GenoaUniversity. Anticancer Res2010; 30: 4749–4753 
8-Shahid A, Athar MA, Asghar S, et al: Post mastectomy adjuvant radiotherapy in breast cancer: a comparision of three hypofractionated protocols. J Pak Med Assoc. 2009; 59(5):282-7.
9-El-Hadaad, H.A., Wahba, H.A., Elnahas, W. and Roshdy, S. (2016) Concomitant Boost Radiotherapyafter Conservative Breast Surgery in Early Breast Cancer. Advances in Breast Cancer Research, 5, 97-102.
10-Disipio T, Rye S, and Newman B: Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 2013 ;14(6):500-15.