Background: Breast cancer is the most common malignant neoplasm and a leading cause of death in women worldwide. Radiation therapy for breast cancer is usually performed after surgery and is an integral component of breast-conserving therapy as well as after post mastectomy. The dose of radiation must be strong enough to ensure the eradication of cancer cells.

Objectives: To compare two different dose fractionation radiotherapy schedules in terms of: a) Loco regional control & distant metastasis b) Acute and late radiation induced toxicities.

Methodology:  Study was prospective and patients were divided into two groups- Group A and Group B. Group A- These patients were given Accelerated Hypofractionated Schedule (Study group) – 40 Gy/17 fractions/3.2 weeks @ 2.35 Gy/fraction. Group B- These patients were given Conventional Fractionation Schedule (Control group) - 50 Gy/25 fractions/5 weeks @ 2 Gy/fraction.

Results: The median age of patients in both groups was 47 years, and patients were followed up till 18 months. Treatment time in group A and group B were 3.2 weeks and 5 weeks respectively. Patients of both the groups tolerated radiation well with locoregional control, distant metastasis and acute and late radiation reactions comparable in both the groups and there was no difference statistically (p>0.05) . Grade 1 acute radiation dermatitis was the most common reaction. Acute radiation dermatitis in group A and group B was 87% and 85%, late reaction lymphedema was 17% and 15%, locoregional failure was 12% and 15%, distant metastasis was 7.5% and 5%  respectively.

Conclusion: From the present study we concluded that patients in both the regimen groups tolerated the treatment well with non significant difference (p value>0.05) in radiation toxicities. The overall treatment time (O.T.T.) in group A was significantly less in comparison to group B(p value<0.05)

1. Alam Md S, Perween R, Siddiqui AS. Accelerated Hypofractionated Radiation in Carcinoma Breast. Arch Cancer Res. 2016, 4:1.
2. Abhilash GH, Dhull AK, Atri R, et al. Comparison of hypofractionated radiation therapy versus conventional radiation therapy in post mastectomy breast cancer. J. Evid. Based Med. Healthc. 2016; 3(26), 1177-1181. DOI: 10.18410/jebmh/2016/270
3. Sood N, Nigam JS, Yadav P et al. Comparative Study of Cytomorphological Robinson’s Grading for Breast Carcinoma with Modified Bloom-Richardson Histopathological Grading. Pathology Research International, vol. 2013, Article ID 146542, 5 pages, 2013. doi:10.1155/2013/146542
4. Anderson BO et al. (2008). Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer, 113, 2221–43.
5. Gupta A, Shridhar K, Dhillon PK. A review of breast cancer awareness among women in India: Cancer literate or awareness deficit?. European journal of cancer. 2015 Sep 1;51(14):2058-66
6. Coleman MP et al. (2008). Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol, 9, 730–56.7
7. Kumbhaj PR, Sharma R, Saini PK, Patel PR. Study of two different dose fractionation schedules of post mastectomy chest wall irradiation in carcinoma breast patients. Int J Med Sci Public Health. (2013), [cited November 03, 2015]; 2(4): 1001-1005.doi:10.5455/ijmsph.2013.0408201317
8. Carlos A, Perez CA, Taylor ME. Breast: Stage Tis, T1 and T2 tumors. In: Perez CA, ed. Principles and practice of radiation oncology. Philadelphia: Lippincott - Raven, 1999;1269-1396.9
9. Will BP, LePetit C, Berthelot JM, Tomiak EM, Verma S. Diagnostic and therapeutic approaches for nonmetastatic breast cancer in Canada, and their associated costs. Br J Cancer. 1999;79,1428-143610
10. Baker RR. The clinical management of primary breast cancer. In Baker RR, ed. Current trends in management of breast cancer. Baltimore: Cassell and Collier Macmillian, 1977;77-12311
11. Chapman JW, Fish EB, Link MA. Competing risks analyses for recur-rence from primary breast cancer. Br J Cancer. 1999;79:1508-151312
12. Yarnold J, Bentzen SM, Coles C, Haviland J (2011)Hypofractionated whole-breast radiotherapy for women with early breast cancer: myths and realities. Int J RadiatOncolBiolPhys 79: 1-9.13
13. Taher AN, El-Baradie MM, Essa H, Zaki O, Ezzat S, et al. (2004)Hypofractionation versus conventional fractionation radiotherapy after conservative treatment of breast cancer: early skin reactions and cosmetic results. J Egypt NatlCancInst 16: 178-187.14
14. Archambeau JO, Pezner R, Wasserman T (1995)Pathophysiology of irradiated skin and breast. Int J RadiatOncolBiolPhys 31: 1171-1185.15
15. Awwad HK (1990) Dose-Time-Volume relationships in normal tissue to radiation. In Radiation Oncology: Radiobiological and Physiological Prespective. Kluwer Academic, Dordecht, Boston, London, 129-187.16
16. Deantonio L, Gambaro G, Beldì D, Masini L, Tunesi S, et al. (2010)Hypofractionated radiotherapy after conservative surgery for breast cancer: analysis of acute and late toxicity. RadiatOncol 5: 11217
17. Owen JR, Ashton A, Bliss JM, Homewood J, Harper C, et al. (2006)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 7: 467-47118
18. Fowler JF (1989)The linear-quadratic formula and progress in fractionated radiotherapy. Br J Radiol 62: 679-69419
19. Sachs RK, Hahnfeld P, Brenner DJ (1997)The link between low-LET dose-response relations and the underlying kinetics of damage production/repair /misrepair. Int J RadiatBiol 72: 351-374.20
20. El-Sayed MI, Abdel-Wanis ME (2012) Comparison of Hypofractionated and Conventional Radiotherapy Protocols in Breast Cancer Patients: A Retrospective Study. J Cancer SciTher 4: 158-163. doi: 10.4172/1948-5956.100013221
21. Gorey KM, Luginaah IN, Holowaty EJ, Fung KY, Hamm C. Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: greater socioeconomic inequity in America. Clin Invest Med. 2009, 32:E239-E24923
22. Kaufmann M, Morrow M, Von Minckwitz G, Harris JR. Locoregional treatment of primary breast cancer: consensus recommendations from an International Expert Panel. Cancer. 2010, 116:1184-119123
23. Veronesi U, Orecchia R, Luini A, Galimberti V, Zurrida S, Intra M et al. Intraoperative radiotherapy during breast conserving surgery: a study on 1,822 cases treated with electrons. Breast Cancer Res Treat. 2010;124:141–151.24
24. Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet. 2010;376:91–102.25
25. Beitsch PD, Shaitelman SF, Vicini FA. Accelerated partial breast irradiation. J Surg Oncol. 2011; 103:362–368.26
26. Forrest AP, Stewart HJ, Everington D, et al. Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group. Lancet 1996;348(9029):708–713.27
27. Pinitpatcharalert A et al. A retrospective study comparing hypofractionated radiotherapy and conventional radiotherapy in postmastectomy breast cancer. J Med Assoc Thai. 2011 March; 94 (Suppl 2): S94–102.

Dr Laxmi Singotia

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