Comparison of Acute Radiation Dermatitis between Hypofractionated and Conventional Radiotherapy in Postmastectomy Breast Cancer
Keywords:
Breast cancer; radiotherapy; acute radiation dermatitis; hypofractionatedAbstract
Objective: To compare the acute radiation dermatitis between hypofractionated radiotherapy (HFRT) and conventional radiotherapy (CRT) in postmastectomy breast cancer.
Methods: This study was the experimental research design (randomized controlled trial). Seventy six patients underwent a mastectomy and divided into two groups with 38 cases in group I used HFRT regimen 42.56 Gy in 16 fractions over three weeks and 38 cases in group 2 used CRT regimen 50 Gy in 25 fractions over five weeks. The study was performed at Division of Radiation Oncology, Roi Et Hospital, from January 1, 2019, to April 30, 2020. All cases were categorized in different grading of acute radiation dermatitis by Radiation Oncologist at Week 1,2,3 during radiation and 1 month, 3 months post-radiation. The statistical analyzed were used descriptive statistics and Z-test. The statistical significance was set at p<0.05.
Results: There was no significant difference of acute radiation dermatitis in CRT and HFRT. We found that acute radiation dermatitis grade 1 at week 1,2and 3 during radiotherapy of CRT vs HFRT was 5.26% vs.7.89% (p=0.644), 28.95% vs. 18.42% (p=0.280), 50% vs. 28.95% (p=0.085), respectively. Acute radiation dermatitis grade 1 of the first-month postmastectomy radiation was 15.79% vs. 10.53% (p=0.301) in patients treated with CRT vs. HFRT. Dermatitis grade 1 was the most common grade for acute radiation dermatitis. Few patients in this study developed grade 2 or more skin toxicities.
Conclusion: This study revealed that the treatment outcome of acute radiation dermatitis between HFRT (42.56 Gy in 16 fractions) and CRT (50Gy in 25 fractions) in postmastectomy breast cancer was not different. Hypofractionated radiotherapy is shortening treatment time, reduces cost-saving, and more convenient.
References
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16. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347(16): 1233–1241.
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21. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol Off J Am Soc Clin Oncol 2000; 18(6): 1220–1229.
22. Recht A, Gray R, Davidson NE, Fowble BL, Solin LJ, Cummings FJ, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol Off J Am Soc Clin Oncol 1999; 17(6): 1689–1700.
23. Katz A, Strom EA, Buchholz TA, Thames HD, Smith CD, Jhingran A, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol Off J Am Soc Clin Oncol 2000 ; 18(15): 2817–2827.
24. Taghian A, Jeong J-H, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol Off J Am Soc Clin Oncol 2004; 22(21): 4247–4254.
25. Whelan TJ, Pignol J-P, 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): 513–520.
26. START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EGA, Barrett JM, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Lond Engl 2008; 371(9618): 1098–1107.
27. START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EGA, Barrett JM, Barrett-Lee PJ, 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(4): 331–341.
28. Hickey BE, James ML, Lehman M, Hider PN, Jeffery M, Francis DP, et al. Fraction size in radiation therapy for breast conservation in early breast cancer. Cochrane Database Syst Rev 2016; 7: CD003860.
29. Valle LF, Agarwal S, Bickel KE, Herchek HA, Nalepinski DC, Kapadia NS. Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials. Breast Cancer Res Treat 2017; 162(3): 409–417.
30. Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, Hahn C, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol 2018; 8(3): 145–152.
31. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, 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(11): 1086–1094.
32. 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(6): 467–471.
33. 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 J Eur Soc Ther Radiol Oncol 2005; 75(1): 9–17.
34. Rastogi K, Jain S, Bhatnagar AR, Bhaskar S, Gupta S, Sharma N. A Comparative Study of Hypofractionated and Conventional Radiotherapy in Postmastectomy Breast Cancer Patients. Asia-Pac J Oncol Nurs 2018; 5(1): 107–113.
35. Kouloulias V, Mosa E, Zygogianni A, Kypraiou E, Georgakopoulos J, Platoni K, et al. A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer. Breast Care Basel Switz 2016; 11(5): 328–332.
36. Ko D-HI, Norriss A, Harrington CR, Robinson BA, James ML. Hypofractionated radiation treatment following mastectomy in early breast cancer: the Christchurch experience. J Med Imaging Radiat Oncol 2015; 59(2): 243–247.
37. Tovanabutra C, Katanyoo K, Uber P, Chomprasert K, Sukauichai S. Comparison of Treatment Outcome between Hypofractionated Radiotherapy and Conventional Radiotherapy in Postmastectomy Breast Cancer. Asian Pac J Cancer Prev APJCP 2020; 21(1): 119–125.
38. Wang S-L, Fang H, Song Y-W, Wang W-H, Hu C, Liu Y-P, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol 2019; 20(3): 352–360.
2. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet Lond Engl 2015; 385(9972): 977–1010.
3. Shibuya K, Mathers CD, Boschi-Pinto C, Lopez AD, Murray CJ. Global and regional estimates of cancer mortality and incidence by site: II. results for the global burden of disease 2000. BMC Cancer 2002; 2: 37.
4. Arnold M, Pandeya N, Byrnes G, Renehan PAG, Stevens GA, Ezzati PM, et al. Global burden of cancer attributable to high body-mass index in 2012: a population-based study. Lancet Oncol 2015; 16(1): 36–46.
5. Ferlay J, Shin H-R, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer J Int Cancer 2010; 127(12): 2893–917.
6. Shama Virani, Surichai Bilheem, Wasan Chansaard, Imjai Chitapanarux, Karnchana Daoprasert, Somsak Khuanchana, et al. National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens. Cancers (Basel) 2017; 9(8): 108.
7. มะเร็งเต้านม. In: วิกิพีเดีย [Internet]. 2019. [Cited September 15, 2020]; Available from: https://th.wikipedia.org/w/index.php
8. Yi-Sheng Sun, Zhao Zhao, Zhang-Nv Yang , Fang Xu , Hang-Jing Lu, Zhi-Yong Zhu , et al. Risk Factors and Preventions of Breast Cancer [Internet]. International journal of biological sciences. Int J Biol Sci 2017 ; 13(11): 1387-1397. doi: 10.7150/ijbs.21635. eCollection 2017.
9. Kristin Rojas, Ashley Stuckey Breast Cancer Epidemiology and Risk Factors [Internet]. Clinical obstetrics and gynecology. Clin Obstet Gynecol 2016; 59(4): 651-672. doi: 10.1097/GRF.0000000000000239.
10. Stella Winters, Charmaine Martin , Daniel Murphy, Navkiran K Shokar. Breast Cancer Epidemiology, Prevention, and Screening. Prog Mol Biol Transl Sci 2017; 151: 1-32. doi: 10.1016/bs.pmbts.2017.07.002.
11. Zhang L, Huang Y, Feng Z, Wang X, Li H, Song F, et al. Comparison of breast cancer risk factors among molecular subtypes: A case‐only study. Cancer Med 2019 14; 8(4): 1882–1892.
12. Yedjou CG, Sims JN, Miele L, Noubissi F, Lowe L, Fonseca DD, et al. Health and Racial Disparity in Breast Cancer. Adv Exp Med Biol 2019; 1152: 31–49.
13. Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer. N Engl J Med 2002; 347(16): 1227–1232.
14. Litière S, Werutsky G, Fentiman IS, Rutgers E, Christiaens M-R, Van Limbergen E, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol 2012; 13(4): 412–419.
15. Liljegren G, Holmberg L, Bergh J, Lindgren A, Tabár L, Nordgren H, et al. 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol Off J Am Soc Clin Oncol 1999; 17: 2326–2333.
16. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347(16): 1233–1241.
17. Taylor ME, Perez CA, Halverson KJ, Kuske RR, Philpott GW, Garcia DM, et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys 1995; 31(4): 753–764.
18. Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Oswald MJ, Outlaw ED, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience. J Clin Oncol Off J Am Soc Clin Oncol 2004; 22: 2303–2312.
19. Chen AM, Meric-Bernstam F, Hunt KK, Thames HD, Outlaw ED, Strom EA, et al. Breast conservation after neoadjuvant chemotherapy. Cancer 2005; 103(4): 689–695.
20. EBCTCG (Early Breast Cancer Trialists’ Collaborative Group), McGale P, Taylor C, Correa C, Cutter D, Duane F, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet Lond Engl 2014; 383(9935): 2127–2135.
21. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML. Does locoregional radiation therapy improve survival in breast cancer? A meta-analysis. J Clin Oncol Off J Am Soc Clin Oncol 2000; 18(6): 1220–1229.
22. Recht A, Gray R, Davidson NE, Fowble BL, Solin LJ, Cummings FJ, et al. Locoregional failure 10 years after mastectomy and adjuvant chemotherapy with or without tamoxifen without irradiation: experience of the Eastern Cooperative Oncology Group. J Clin Oncol Off J Am Soc Clin Oncol 1999; 17(6): 1689–1700.
23. Katz A, Strom EA, Buchholz TA, Thames HD, Smith CD, Jhingran A, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol Off J Am Soc Clin Oncol 2000 ; 18(15): 2817–2827.
24. Taghian A, Jeong J-H, Mamounas E, Anderson S, Bryant J, Deutsch M, et al. Patterns of locoregional failure in patients with operable breast cancer treated by mastectomy and adjuvant chemotherapy with or without tamoxifen and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol Off J Am Soc Clin Oncol 2004; 22(21): 4247–4254.
25. Whelan TJ, Pignol J-P, 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): 513–520.
26. START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EGA, Barrett JM, Barrett-Lee PJ, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Lond Engl 2008; 371(9618): 1098–1107.
27. START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EGA, Barrett JM, Barrett-Lee PJ, 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(4): 331–341.
28. Hickey BE, James ML, Lehman M, Hider PN, Jeffery M, Francis DP, et al. Fraction size in radiation therapy for breast conservation in early breast cancer. Cochrane Database Syst Rev 2016; 7: CD003860.
29. Valle LF, Agarwal S, Bickel KE, Herchek HA, Nalepinski DC, Kapadia NS. Hypofractionated whole breast radiotherapy in breast conservation for early-stage breast cancer: a systematic review and meta-analysis of randomized trials. Breast Cancer Res Treat 2017; 162(3): 409–417.
30. Smith BD, Bellon JR, Blitzblau R, Freedman G, Haffty B, Hahn C, et al. Radiation therapy for the whole breast: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol 2018; 8(3): 145–152.
31. Haviland JS, Owen JR, Dewar JA, Agrawal RK, Barrett J, Barrett-Lee PJ, 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(11): 1086–1094.
32. 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(6): 467–471.
33. 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 J Eur Soc Ther Radiol Oncol 2005; 75(1): 9–17.
34. Rastogi K, Jain S, Bhatnagar AR, Bhaskar S, Gupta S, Sharma N. A Comparative Study of Hypofractionated and Conventional Radiotherapy in Postmastectomy Breast Cancer Patients. Asia-Pac J Oncol Nurs 2018; 5(1): 107–113.
35. Kouloulias V, Mosa E, Zygogianni A, Kypraiou E, Georgakopoulos J, Platoni K, et al. A Retrospective Analysis of Toxicity and Efficacy for 2 Hypofractionated Irradiation Schedules Versus a Conventional One for Post-Mastectomy Adjuvant Radiotherapy in Breast Cancer. Breast Care Basel Switz 2016; 11(5): 328–332.
36. Ko D-HI, Norriss A, Harrington CR, Robinson BA, James ML. Hypofractionated radiation treatment following mastectomy in early breast cancer: the Christchurch experience. J Med Imaging Radiat Oncol 2015; 59(2): 243–247.
37. Tovanabutra C, Katanyoo K, Uber P, Chomprasert K, Sukauichai S. Comparison of Treatment Outcome between Hypofractionated Radiotherapy and Conventional Radiotherapy in Postmastectomy Breast Cancer. Asian Pac J Cancer Prev APJCP 2020; 21(1): 119–125.
38. Wang S-L, Fang H, Song Y-W, Wang W-H, Hu C, Liu Y-P, et al. Hypofractionated versus conventional fractionated postmastectomy radiotherapy for patients with high-risk breast cancer: a randomised, non-inferiority, open-label, phase 3 trial. Lancet Oncol 2019; 20(3): 352–360.
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2021-01-18
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Nirunsiriphol S. Comparison of Acute Radiation Dermatitis between Hypofractionated and Conventional Radiotherapy in Postmastectomy Breast Cancer. SRIMEDJ [Internet]. 2021 Jan. 18 [cited 2024 Nov. 5];36(1):15-23. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/248653
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