Skip to main content

Advertisement

SpringerLink
Log in

Hypofractionated whole breast radiotherapy with or without hypofractionated boost in early stage breast cancer patients: a mono-institutional analysis of skin and subcutaneous toxicity

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

Our study evaluated skin and subcutaneous toxicity analyzing its correlation with patient- and treatment-related factors in a large mono-institutional series of women with early stage breast cancer treated with adjuvant hypofractionated whole breast radiotherapy (WBRT) with or without a sequential hypofractionated boost (HB).

Methods

Two hundred and nineteen patients, median age 62 years, received adjuvant hypofractionated WBRT in 16 fractions to a total dose of 42.4 Gy. Patients with negative prognostic factors received a HB of 2.65 Gy for 4 or 5 (patients with focal positive surgical margins) fractions. Systemic adjuvant treatments were hormonal therapy (HT) and/or chemotherapy (CHT) and/or Trastuzumab. Toxicities were assessed using the Common Terminology Criteria for Adverse Events (CTCAE 4.03) scale at 5th, 10th, 16th, 20th day from the start of radiotherapy (RT) and 1, 6 and 12 months after the end of RT. Univariate and multivariate analysis estimated toxicity predictive factors.

Results

No case of treatment interruption and no acute or late G3 toxicities occurred. In the univariate analysis HB administration resulted a risk factor for acute toxicity, while CHT administration and number of excised lymph nodes ≥ 10 resulted a risk factor for late toxicity. In the multivariate analysis none of the evaluated factors emerged a risk factor for acute and/or late toxicity.

Conclusions

Our results confirmed that hypofractionated WBRT even followed by a HB resulted safe and well tolerated. Longer follow-up is warranted to estimate late toxicity and treatment outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, 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; 378:1707–16.

    Article  Google Scholar 

  2. Vrieling C, van Werkhoven E, Maingon P, Poortmans P, Weltens C, Fourquet A, European Organisation for Research and Treatment of Cancer, Radiation Oncology and Breast Cancer Groups, et al. Prognostic factors for local control in breast cancer after long-term follow-up in the EORTC boost vs no boost trial: a randomized clinical trial. JAMA Oncol. 2017;3:42–8.

    Article  PubMed  Google Scholar 

  3. Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, Hanson J, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol. 2006;7:467–71.

    Article  PubMed  Google Scholar 

  4. Yarnold J, Ashton A, Bliss J, Homewood J, Harper C, Hanson J, et al. Fractionation sensitivity and dose response of late adverse effects in the breast after radiotherapy for early breast cancer: long-term results of a randomised trial. Radiother Oncol. 2005;75:9–17.

    Article  PubMed  Google Scholar 

  5. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, START Trialists’ Group, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol. 2013;14:1086–94.

    Article  PubMed  Google Scholar 

  6. Hopwood P, Haviland JS, Sumo G, Mills J, Bliss JM, Yarnold JR, START Trial Management Group. Comparison of patient-reported breast, arm, and shoulder symptoms and body image after radiotherapy for early breast cancer: 5-year follow-up in the randomised Standardisation of Breast Radiotherapy (START) trials. Lancet Oncol. 2010;11:231–40.

    Article  PubMed  Google Scholar 

  7. START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bentzen SM, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;371:1098–107.

    Article  Google Scholar 

  8. START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EG, Barrett JM, Barrett-Lee PJ, Bliss JM, et al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008;9:331–41.

    Article  Google Scholar 

  9. Whelan TJ, Pignol JP, Levine MN, Julian JA, MacKenzie R, Parpia S, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20.

    Article  CAS  Google Scholar 

  10. Paelinck L, Gulyban A, Lakosi F, Vercauteren T, De Gersem W, Speleers B, et al. Does an integrated boost increase acute toxicity in prone hypofractionated breast irradiation? A randomized controlled trial. Radiother Oncol. 2017;122(1):30–6.

    Article  PubMed  Google Scholar 

  11. Ahlawat S, Haffty BG, Goyal S, Kearney T, Kirstein L, Chen C, et al. Short-course hypofractionated radiation therapy with boost in women with stages 0 to IIIa breast cancer: a phase 2 trial. Int J Radiat Oncol Biol Phys. 2016;94:118–25.

    Article  PubMed  Google Scholar 

  12. Pinnarò P, Soriani A, Landoni V, Giordano C, Papale M, Marsella A, et al. Accelerated hypofractionated radiotherapy as adjuvant regimen after conserving surgery for early breast cancer: interim report of toxicity after a minimum follow up of 3 years. J Exp Clin Cancer Res. 2010;29:9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Sanz J, Rodríguez N, Foro P, Dengra J, Reig A, Pérez P, et al. Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis. Clin Transl Oncol. 2017;19:464–9.

    Article  CAS  PubMed  Google Scholar 

  14. Pinnarò P, Giordano C, Farneti A, Faiella A, Iaccarino G, Landoni V, et al. Short course hypofractionated whole breast irradiation after conservative surgery: a single institution phaseII study. J Exp Clin Cancer Res. 2017;36(1):191.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Deantonio L, Cozzi S, Tunesi S, Brambilla M, Masini L, Pisani C, et al. Hypofractionated radiation therapy for breast cancer: long-term results in a series of 85 patients. Tumori. 2016;102(4):398–403.

    Article  CAS  PubMed  Google Scholar 

  16. Deantonio L, Gambaro G, Beldì D, Masini L, Tunesi S, Magnani C, et al. Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity. Radiat Oncol. 2010;5:112.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Linares I, Tovar MI, Zurita M, Guerrero R, Expósito M, Del Moral R. Hypofractionated breast radiation: shorter scheme, lower toxicity. Clin Breast Cancer. 2016;16(4):262–8.

    Article  PubMed  Google Scholar 

  18. Ciammella P, Podgornii A, Galeandro M, Micera R, Ramundo D, Palmieri T, et al. Toxicity and cosmetic outcome of hypofractionated whole-breast radiotherapy: predictive clinical and dosimetric factors. Radiat Oncol. 2014;9:97.

    Article  PubMed  PubMed Central  Google Scholar 

  19. De Santis MC, Bonfantini F, Di Salvo F, Dispinzieri M, Mantero E, Soncini F, et al. Factors influencing acute and late toxicity in the era of adjuvant hypofractionated breast radiotherapy. Breast. 2016;29:90–5.

    Article  PubMed  Google Scholar 

  20. De Santis MC, Bonfantini F, Di Salvo F, Fiorentino A, Riboldi VM, Di Cosimo S, et al. Trastuzumab and hypofractionated whole breast radiotherapy: a victorious combination? Clin Breast Cancer. 2018;18:e363-e71.

    Google Scholar 

  21. De Santis MC, Bonfantini F, Di Salvo F, Fiorentino A, Dispinzieri M, Caputo M, et al. Hypofractionated whole-breast irradiation with or without boost in elderly patients: clinical evaluation of an italian experience. Clin Breast Cancer. 2018;18:e363–71.

    Article  CAS  PubMed  Google Scholar 

  22. Cante D, Petrucci E, Sciacero P, Piva C, Ferrario S, Bagnera S, et al. Ten-year results of accelerated hypofractionated adjuvant whole-breast radiation with concomitant boost to the lumpectomy cavity after conserving surgery for early breast cancer. Med Oncol. 2017;34(9):152.

    Article  PubMed  Google Scholar 

  23. Guenzi M, Vagge S, Azinwi NC, D’Alonzo A, Belgioia L, Garelli S, 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.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mondal D, Julka PK, Sharma DN, Jana M, Laviraj MA, Deo SV, et al. Accelerated hypofractionated adjuvant whole breast radiation with simultaneous integrated boost using volumetric modulated arc therapy for early breast cancer: A phase I/II dosimetric and clinical feasibility study from a tertiary cancer care centre of India. J Egypt Natl Cancer Inst. 2017;29(1):39–45.

    Article  Google Scholar 

  25. Associazione Italiana di Radioterapia Oncologica (AIRO). Gruppo di lavoro per la patologia mammaria. La Radioterapia dei Tumori della Mammella Indicazioni e Criteri Guida; 2013. AIRO Web site. http://www.radioterapiaitalia.it. Accessed July 2018.

  26. Cancer Therapy Evaluation Program. Common Terminology criteria for Adverse Events, Version 4.0; 2009. http://ctep.cancer.gov. Accessed July 2018.

  27. Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley; 2000.

    Book  Google Scholar 

  28. Tortorelli G, Di Murro L, Barbarino R, Cicchetti S, di Cristino D, Falco MD, et al. Standard or hypofractionated radiotherapy in the postoperative treatment of breast cancer: a retrospective analysis of acute skin toxicity and dose inhomogeneities. BMC Cancer. 2013;7:230.

    Article  Google Scholar 

  29. De Felice F, Ranalli T, Musio D, Lisi R, Rea F, Caiazzo R, et al. Relation between hypofractionated radiotherapy, toxicity and outcome in early breast cancer. Breast J. 2017;23:563–8.

    Article  PubMed  Google Scholar 

  30. Payne AS, James WD, Weiss RB. Dermatologic toxicity of chemotherapeutic agents. Semin Oncol. 2006;33:86–97.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, 06156, Perugia, Italy

    Isabella Palumbo, Valentina Lancellotta & Cynthia Aristei

  2. Radiation Oncology Section, University of Perugia, Perugia, Italy

    Cristina Mariucci, Anna Maria Podlesko & Simonetta Saldi

  3. Radiation Oncology Division, Perugia General Hospital, Perugia, Italy

    Lorenzo Falcinelli & Elisabetta Perrucci

  4. Medical Physics Unit, Perugia General Hospital, Perugia, Italy

    Marta Marcantonini

  5. Internal Medicine Endocrine and Metabolic Science Section, University of Perugia, Perugia, Italy

    Vittorio Bini

Authors
  1. Isabella Palumbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Mariucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lorenzo Falcinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabetta Perrucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valentina Lancellotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna Maria Podlesko
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marta Marcantonini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Simonetta Saldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vittorio Bini
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cynthia Aristei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isabella Palumbo.

Ethics declarations

Ethical standards

The study was conducted in accordance with the Helsinki declaration as revised in 2000. Written informed consent was obtained from all patients.

Conflict of interest

The authors declare no conflict of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palumbo, I., Mariucci, C., Falcinelli, L. et al. Hypofractionated whole breast radiotherapy with or without hypofractionated boost in early stage breast cancer patients: a mono-institutional analysis of skin and subcutaneous toxicity. Breast Cancer 26, 290–304 (2019). https://doi.org/10.1007/s12282-018-0923-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-018-0923-z

Keywords

Search

Navigation