| 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. 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. 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%. 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. Copyright © 2012 Elsevier Inc. All rights reserved. |
| Keywords: |
adult; aged; aged, 80 and over; middle aged; intensity modulated radiation therapy; multimodality cancer therapy; combined modality therapy; cancer staging; methodology; neoplasm staging; quality of life; phase 2 clinical trial; neoplasm recurrence, local; tumor volume; pathology; breast neoplasms; radiation exposure; time; time factors; skin; radiotherapy, intensity-modulated; tumor burden; radiation dose fractionation; tumor recurrence; breast tumor; carcinoma in situ; neoplasms, second primary; second cancer; photons; dose fractionation; photon; segmental mastectomy; mastectomy, segmental
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