Toxicity of Hypofractionated Whole Breast Radiotherapy Without Boost and Timescale of Late Skin Responses in a Large Cohort of Early-Stage Breast Cancer Patients

• DOI: 10.1016/j.clbc.2021.11.008
• Publication Date: 2021-12-01T17:03:45Z
• Authors: Andrei Fodor; Chiara Brombin; Paola Mangili; Roberta Tummineri; Marcella Pasetti; Flavia Zerbetto; Barbara Longobardi; Ariadna Sanchez G...; Chiara Lucrezia D...; Italo Dell'Oca; Roberta Castriconi; Pier Giorgio Espo...; Aniko Maria Deli; Paola Maria Vitto...; Claudio Fiorino; Antonella Del Vec...; Mariaclelia Stefa...; Nadia Gisella Di ...
• Keywords: Toxicity of breast cancer radiotherapy; Hypofractionated whole-breast radiotherapy; Breast Neoplasms; Middle Aged; Radiotherapy in conservative breast cancer treatment; Mastectomy, Segmental; 3. Good health; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Radiation Dose Hypofractionation; Radiotherapy, Adjuvant; Breast radiotherapy boost

To report toxicity of hypofractionated whole-breast radiotherapy in a large cohort of early-stage breast cancer (BCaients.From 02/2009-05/2017, 1325 consecutive BCa patients were treated with 40.05 Gy/15 fractions, without boost. Median age was 62 (IQR:51.1-70.5) years. Chemotherapy was prescribed for 28% of patients, hormonal therapy for 80.3%, monoclonal antibodies for 8.2%.Median follow-up was 72.4 (IQR: 44.6-104.1) months. Acute RTOG toxicity was: 69.8% Grade (G) 1, 14.3% G2 and 1.7% G3. Late SOMA-LENT toxicities were: edema-hyperpigmentation (E-H): G1 28.67%, G2 4.41%, G3 0.15%; fibrosis-atrophy-telangiectasia-pain (F-A-T-P): G1 14.6%, G2 3.2%, G3 0.8%, G4 0.1%. Median time to first occurrence was 6 and 18 months, respectively. Aesthetic result after surgery was excellent in 28.7%, good in 41.5%, acceptable in 20.3% and poor in 9.5% of patients. Change in breast appearance after radiotherapy was mild in 6.9%, moderate in 2.3% and marked in 1.3% of patients. Concomitant chemotherapy, obesity, smoking, use of bolus and planning target volume (PTV) were associated with higher acute toxicity. Patients ≥55 years old were less likely to experience acute toxicity. PTV and acute G2 toxicity were associated with ≥G2 E-H. PTV, concomitant chemotherapy, hypertension and ≥G2 acute toxicity were associated with increased risk of F-A-T-P.Hypofractionated whole-breast radiotherapy without boost demonstrated mild acute and late toxicity in a large cohort of consecutive patients. Moderate and marked changes in breast appearance were registered for 3.6% of patients and occurred between 18 to 42 months.