An accelerated hypofractionated schedule with a daily concomitant boost after breast conservation surgery : the feasibility and toxicity

Abstract EN

Aims and background: Reduction of overall treatment time of postoperative irradiation and evaluation of the feasibility and preliminary toxicity of an accelerated hypofractionated whole breast irradiation with an addition of a concomitant daily boost in patients with early breast cancer submitted to conservation surgery.

Materials: Between June 2010 and September 2011, 122 patients underwent accelerated hypofractionated adjuvant radiation after conservation surgery (pT1 or pT2, pN0-N1).

Radiotherapy consisted of 45 Gy, to the whole breast in 20 fractions with 2.25 Gy/fraction; an additional daily boost dose of 0.25 Gy was concomitantly delivered to the lumpectomy cavity, total dose 5 Gy.

Toxicity was assessed at the end of radiation therapy and at 3, 6, and 12 months using the RTOG/EORTC toxicity scale.

Cosmetic results were assessed in agreement with the Harvard criteria.

Results : Median follow-up was 31 months, 74% showed grade 0–1 skin toxicity, 20 % grade 2, and 6 % grade 3.

At 3 months of follow-up, grade 0 skin toxicity was observed in 51% of cases ; grade 1 in 36 %, and grade 2 in 13 %.

At 6 months, late skin and subcutaneous tissue toxicities were scored as grade 0 in 71 %, grade 1 in 18 %, and grade 2 in 11 % of patients.

At 1 year almost all the patients showed grade 0–1 skin toxicity.

97 % of patients showed excellent or good cosmetic results.

Conclusions : Accelerated hypofractionated radiotherapy for early breast cancer with concomitant electron boost seems to be feasible providing consistent clinical results with acceptable toxicity profile.