Five-year Local Control on a Phase II Study of Hypofractionated Intensity Modulated Radiation Therapy with an Incorporated Boost for Early Stage Breast Cancer

• Type of Material: Article
• Authors: Gary M. Freedman, University of Pennsylvania; Penny R. Anderson, Fox Chase Cancer Center; Richard J. Bleicher, Fox Chase Cancer Center; Samuel Litwin, Fox Chase Cancer Center; Tianyu Li, Fox Chase Cancer Center; Ramona F. Swaby, Fox Chase Cancer Center; Chang-Ming Charlie Ma, Fox Chase Cancer Center; Jinsheng Li, Fox Chase Cancer Center; Elin R. Sigurdson, Fox Chase Cancer Center; Deborah W. Bruner, Emory University; Monica Morrow, Memorial Sloan Kettering Cancer Center; Lori Goldstein, Fox Chase Cancer Center
• Language: English
• Date: 2012-11-15
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijrobp.2012.01.091
• Title of Journal or Parent Work: International Journal of Radiation Oncology - Biology - Physics
• ISSN: 0360-3016
• Volume: 84
• Issue: 4
• Start Page: 888
• End Page: 893
• Keywords: RADIOTHERAPY HYPOFRACTIONATION; Oncology; Hypofractionation; Breast boost; SURGERY; WOMEN; Radiation therapy; IMRT; Life Sciences & Biomedicine; SURVIVAL; RANDOMIZED-TRIAL; UK STANDARDIZATION; CARCINOMA; Breast cancer; IRRADIATION; Radiology, Nuclear Medicine & Medical Imaging; Science & Technology; QUALITY-OF-LIFE; CONSERVING SURGICAL-PROCEDURES
• Research Categories: Health Sciences, Radiology; Health Sciences, Nursing; Health Sciences, Oncology

Abstract

Conventional radiation fractionation of 1.8-2 Gy per day for early stage breast cancer requires daily treatment for 6-7 weeks. We report the 5-year results of a phase II study of intensity modulated radiation therapy (IMRT), hypofractionation, and incorporated boost that shortened treatment time to 4 weeks. Methods and Materials: The study design was phase II with a planned accrual of 75 patients. Eligibility included patients aged ≥18 years, Tis-T2, stage 0-II, and breast conservation. Photon IMRT and an incorporated boost was used, and the whole breast received 2.25 Gy per fraction for a total of 45 Gy, and the tumor bed received 2.8 Gy per fraction for a total of 56 Gy in 20 treatments over 4 weeks. Patients were followed every 6 months for 5 years. Results: Seventy-five patients were treated from December 2003 to November 2005. The median follow-up was 69 months. Median age was 52 years (range, 31-81). Median tumor size was 1.4 cm (range, 0.1-3.5). Eighty percent of tumors were node negative; 93% of patients had negative margins, and 7% of patients had close ( > 0 and < 2 mm) margins; 76% of cancers were invasive ductal type: 15% were ductal carcinoma in situ, 5% were lobular, and 4% were other histology types. Twenty-nine percent of patients 29% had grade 3 carcinoma, and 20% of patients had extensive in situ carcinoma; 11% of patients received chemotherapy, 36% received endocrine therapy, 33% received both, and 20% received neither. There were 3 instances of local recurrence for a 5-year actuarial rate of 2.7%. Conclusions: This 4-week course of hypofractionated radiation with incorporated boost was associated with excellent local control, comparable to historical results of 6-7 weeks of conventional whole-breast fractionation with sequential boost.