Skip to main content

Advertisement

SpringerLink
Log in

Hypofractionation with no boost after breast conservation in early-stage breast cancer patients

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate local control, survival and toxicity profile of a consecutive cohort of early-stage breast cancer (EBC) patients treated with adjuvant hypofractionated radiotherapy (HF) with no boost delivered to the lumpectomy cavity, after breast-conserving surgery (BCS). Between 2005 and 2015, a total of 493 women affected with EBC were treated with HF (46 Gy/20 fractions or 40.05 Gy/15 fractions) to the whole breast without boost to tumor bed, because of age and/or favorable tumor characteristics. The primary endpoint was 5-year actuarial local control (LC); secondary endpoints included survival, toxicity profile and cosmesis. Median follow-up was 57 months (range 6–124). Actuarial 5-year overall, cancer-specific, disease-free survival and LC were 96.3, 98.9, 97.8 and 98.6 %, respectively. On multivariate analysis, tumor stage (T1 vs. T2) and hormonal status (positive vs. negative estrogen receptors) were significantly correlated with LC. Only 2 % of patients experienced ≥G3 acute skin toxicity. Late toxicity was mild with only 1 case of G3 fibrosis. Most of the patients (95 %) had good–excellent cosmetic results. HF to the whole breast with no boost delivered to the tumor bed is a safe and effective option for a population of low-risk breast cancer patients after BCS, with excellent 5-year LC, mild toxicity profile and promising cosmetic outcome. A subgroup of patients with larger tumors and/or with no estrogen receptor expression may potentially benefit from treatment intensification with a boost dose to the lumpectomy cavity.

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
Fig. 2
Fig. 3

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, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R. 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. Franco P, Zeverino M, Migliaccio F, Sciacero P, Cante D, Casanova Borca V, et al. Intensity-modulated adjuvant whole breast radiation delivered with static angle tomotherapy (TomoDirect): a prospective case series. J Cancer Res Clin Oncol. 2013;139:1927–36.

    Article  PubMed  Google Scholar 

  3. Franco P, Cante D, Sciacero P, Girelli G, La Porta MR, Ricardi U. Tumor bed boost integration during whole breast radiotherapy: a review of the current evidence. Breast Care. 2015;10:44–9.

    Article  PubMed  Google Scholar 

  4. Lievens Y. Hypofractionated breast radiotherapy: financial and economic consequences. Breast. 2010;19:192–7.

    Article  PubMed  Google Scholar 

  5. Mannino M, Yarnold JR. Shorter fractionation schedules in breast cancer radiotherapy: clinical and economic implications. Eur J Cancer. 2009;45:730–1.

    Article  PubMed  Google Scholar 

  6. Cante D, Rosa La Porta M, Casanova-Borca V, Sciacero P, Girelli G, Pasquino M, et al. Accelerated hypofractionated adjuvant breast radiotherapy with concomitant photon boost after conserving surgery for early stage breast cancer: a prospective evaluation on 463 patients. Breast J. 2011;17:586–93.

    Article  PubMed  Google Scholar 

  7. 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;14:1086–94.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  9. Romestaing P, Lehingue Y, Carrie C, Coquard R, Montbarbon X, Ardiet JM, et al. Role of a 10-Gy boost in the conservative treatment of early breast cancer: results of a randomized clinical trial in Lyon, France. J Clin Oncol. 1997;15:963–8.

    CAS  PubMed  Google Scholar 

  10. Bartelink H, Horiot J-C, Poortmans P, Strikmans H, Van den Bogaert W, Fourquet A, et al. Impact of higher radiation dose on local control, survival in breast-conserving therapy of early breast cancer: 10 years results of the randomized boost versus no boost EORTC trial 22881–10882. J Clin Oncol. 2007;25:3259–65.

    Article  PubMed  Google Scholar 

  11. Bartelink H, Maingon P, Poortmans P, Weltens C, Fourquet A, Jager J, et al. Whole breast irradiation with or without a boost for patients treated with breast-conserving surgery for early-breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16:47–56.

    Article  PubMed  Google Scholar 

  12. Harnett A. Fewer fractions of adjuvant external beam radiotherapy for early breast cancer are safe and effective and can now be the standard of care. Why the UK’s NICE accepts fewer fractions as the standard of care for adjuvant radiotherapy in early breast cancer. Breast. 2010;19:159–62.

    Article  PubMed  Google Scholar 

  13. Radiation Therapy Oncology group. Acute radiation morbidity scoring criteria. http://www.rtog.org. Accessed 12 June 2016.

  14. National Cancer Institute Cancer Therapy Evaluation Program. Common toxicity criteria for adverse events. Version 3.0. http://ctep.cancer.gov. Accessed 12 June 2016.

  15. Rose MA, Olivotto IA, Cady B, Koufman C, Osteen R, Silver B, Recht A, Harris JR. Conservative surgery and radiation therapy for early stage breast cancer: long-term cosmetic results. Arch Surg. 1989;124:153–7.

    Article  CAS  PubMed  Google Scholar 

  16. Chung A, Gangi A, Amersi F, Bose S, Zhang X, Giuliano A. Impact of consensus guidelines by the society of surgical oncology and the american society for radiation oncology on margins for breast-conserving surgery in stages 1 and 2 invasive breast cancer. Ann Surg Oncol. 2015;22:422–7.

    Article  Google Scholar 

  17. van Laar C, van der Sangen MJ, Poortmans P, Nieuwenhuijzen GA, Roukema JA, Roumen RM. Local recurrence following breast conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients. Eur J Cancer. 2013;49:3093–101.

    Article  PubMed  Google Scholar 

  18. Franco P, Zeverino M, Migliaccio F, Cante D, Sciacero P, Casanova Borca V, et al. Intensity-modulated and hypofractionated simultaneous integrated boost adjuvant breast radiation employing statics ports of tomotherapy (TomoDirect): a prospective phase II trial. J Cancer Res Clin Oncol. 2014;140:167–77.

    Article  CAS  PubMed  Google Scholar 

  19. 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 

  20. Whelan T, MacKenzie R, Julian J, Levine M, Shelley W, Grimard L, et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94:1143–50.

    Article  PubMed  Google Scholar 

  21. Cante D, Franco P, Sciacero P, Girelli G, Marra AM, Pasquino M, et al. Five-year results of a prospective case series of accelerated hypofractionated whole breast radiation with concomitant boost to the tumor bed after conserving surgery for early breast cancer. Med Oncol. 2013;30:518.

    Article  PubMed  Google Scholar 

  22. Hunt KK, Ballman KV, McCall LM, Boughey JC, Mittendorf EA, Cox CE, et al. Factors associated with local-regional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial. Ann Surg Oncol. 2012;256:428–36.

    Article  Google Scholar 

  23. Jones HA, Antonini N, Hart AA, Peterse JL, Horiot JC, Collin F, et al. Impact of pathological characteristics on local relapse after breast-conserving therapy: a subgroup analysis of the EORTC boost versus no boost trial. J Clin Oncol. 2009;27:4939–47.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Van Werkhoven E, Hart G, van Tinteren H, Elkhuizen P, Collette L, Poortmans P, et al. Nomogram to predict ipsilateral breast relapse based on pathology review from EORTC 22881–10882 boost versus no boost trial. Radiother Oncol. 2011;100:101–7.

    Article  PubMed  Google Scholar 

  25. Samaan NA, Buzdar AU, Aldinger KA, Schultz PN, Yang KP, Romsdahl MM, et al. Estrogen receptor: a prognostic factor in breast cancer. Cancer. 1981;47:554–60.

    Article  CAS  PubMed  Google Scholar 

  26. Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 2006;295:2492–500.

    Article  CAS  PubMed  Google Scholar 

  27. Cante D, Franco P, Sciacero P, Girelli G, Pasquino M, Casanova Borca V, et al. Hypofractionated whole-breast radiotherapy and concomitant boost after breast conservation in elderly patients. Tumori. 2016;102:196–202.

    Article  PubMed  Google Scholar 

  28. Cante D, Franco P, Sciacero P, Girelli G, Marra AM, Pasquino M, et al. Hypofractionation and concomitant boost to deliver adjuvant whole-breast radiation in ductal carcinoma in situ (DCIS): a subgroup analysis of a prospective case series. Med Oncol. 2014;31:838.

    Article  PubMed  Google Scholar 

  29. de Azambuja E, Cardoso F, de Castro G, Jr Colozza M, Mano MS, Durbecq VM, et al. Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients. Br J Cancer. 2007;96:1504–13.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stuart-Harris R, Caldas C, Pinder SE, Pharoah P. Proliferation markers and survival in early breast cancer: a systematic review and meta-analysis of 85 studies in 32,825 patients. Breast. 2008;17:323–34.

    Article  CAS  PubMed  Google Scholar 

  31. Cheang MC, Chia SK, Voduc D, Gao D, Leung S, Snider J, et al. Ki67 index, HER2 status, and prognosis of patients with luminal B breast cancer. J Natl Cancer Inst. 2009;101:736–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Fiets WE, van Helvoirt RP, Nortier JW, van der Tweel I, Struikmans H. Acute toxicity of concurrent adjuvant radiotherapy and chemotherapy (CMF or AC) in breast cancer patients. A prospective, comparative, non-randomised study. Eur J Cancer. 2003;39:1081–8.

    Article  CAS  PubMed  Google Scholar 

  33. Filippi AR, Franco P, Ricardi U. Is clinical radiosensitivity a complex genetically controlled event? Tumori. 2006;92:87–91.

    CAS  PubMed  Google Scholar 

  34. Rovea P, Fozza A, Franco P, De Colle C, Cannizzaro A, Di Dio A, et al. Once-weekly hypofractionated whole-breast radiotherapy after breast-conserving surgery in older patients: a potential alternative treatment schedule to daily 3-week hypofractionation. Clin Breast Cancer. 2015;15:270–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oncology, Radiation Oncology, University of Turin School of Medicine, Via Genova 3, 10126, Turin, Italy

    Francesca Arcadipane, Pierfrancesco Franco, Chiara De Colle, Jacopo Di Muzio, Emanuela Pelle, Stefania Martini, Riccardo Ragona & Umberto Ricardi

  2. Department of Oncology, Radiation Oncology, AOU Città della Salute e della Scienza, Turin, Italy

    Nadia Rondi

  3. Department of General and Specialistic Surgery, Breast Surgery Unit, AOU Città della Salute e della Scienza, Turin, Italy

    Ada Ala

  4. Department of Oncology, Medical Oncology 2, AOU Città della Salute e della Scienza, Turin, Italy

    Mario Airoldi

  5. Department of Oncology, Breast Oncology Unit, AOU Città della Salute e della Scienza, Turin, Italy

    Michela Donadio

  6. Department of Gynecology and Obstetrics, Breast Unit, AOU Città della Salute e della Scienza, Turin, Italy

    Corrado De Sanctis

  7. Department of Medical Sciences, Pathology Unit, University of Torino, Turin, Italy

    Isabella Castellano

Authors
  1. Francesca Arcadipane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pierfrancesco Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chiara De Colle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nadia Rondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacopo Di Muzio
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emanuela Pelle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stefania Martini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ada Ala
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mario Airoldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Michela Donadio
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Corrado De Sanctis
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Isabella Castellano
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Riccardo Ragona
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Umberto Ricardi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierfrancesco Franco.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Approval

The present study has been reviewed and approved by the Research Committee of our institution.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arcadipane, F., Franco, P., De Colle, C. et al. Hypofractionation with no boost after breast conservation in early-stage breast cancer patients. Med Oncol 33, 108 (2016). https://doi.org/10.1007/s12032-016-0821-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-016-0821-1

Keywords

Search

Navigation