Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations.
Materials and methods
47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups.
After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters.
Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
All data are avalaible for analysis and review in electronic records.
Fisher B, Anderson S, Bryant J, 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;347:1233–41.
Darby S, McGale P, Correa C, et al. Early breast cancer trialists’ collaborative group: 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.
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.
Bentzen SM, Agrawal RK, Aird EG. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. The Lancet. 2008;371:1098–107.
Sanz J, Rodríguez N, Foro P, et al. Hypofractionated boost after whole breast irradiation in breast carcinoma: chronic toxicity results and cosmesis. Clin Transl Oncol. 2017;19(4):464–9.
Greenlee RT, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin. 2001;51:15–36.
Algara M, Sanz J, Foro P, Reig A, Lozano J, Membrive I, Lacruz M, Quera J, Fernández-Velilla E, Rodríguez de Dios N. Variación en las indicaciones de irradiación externa en el cáncer de mama. Análisis de 4.545 casos (1990-2005). Rev Senología y Patol Mam. 2007;20(3):120–4.
Punglia RS, Weeks JC, Neville BA, Earle CC. Effect of distance to radiation treatment facility on use of radiation therapy after mastectomy in elderly women. Int J Radiat Oncol Biol Phys. 2006 Sep 1;66(1):56–63.
Morrow M. Breast disease in elderly women. Surg Clin North Am. 1994;74:145–61.
Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 2001;285:885–92.
Donato V, Valeriani M, Zurlo A. Short course radiation therapy for elderly cancer patients. Evidences from the literature review. Crit Rev Oncol/Hematol. 2003;45(3):305–11.
Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000;92:550–6.
Rovea P, Fozza A, Franco P, De Colle C. 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(4):270–6.
Kirova YM, Campana F, Savignoni A, et al. Breast-conserving treatment in the elderly: long-term results of adjuvant hypofractionated and normofractionated radiotherapy. Int J Radiat Oncol Biol Phys. 2009;75:76–81.
Sanz J, Zhao M, Rodríguez N, Granado R, Foro P, et al. Once-weekly hypofractionated radiotherapy for breast cancer in elderly patients: efficacy and tolerance in 486 patients. Biomed Res Int. 2018;2018:8321871.
Holloway CL, Panet-Raymond V, Olivotto I. Hypofractionation should be the new ‘standard’ for radiation therapy after breast conserving surgery. Breast. 2010;19:163–7.
Fiorentino A, Gregucci F, Mazzola R, et al. Intensity-modulated radiotherapy and hypofractionated volumetric modulated arc therapy for elferly patients with breast cancer: comparison of acute and late toxicities. Radiol Med. 2019;124(4):309–14.
Rodríguez N, Sanz X, Dengra J, et al. Five-year outcomes, cosmesis, and toxicity with 3-dimensional conformal external beam radiation therapy to deliver accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys. 2013;87(5):1051–7.
Martin S, Mannino M, Rostom A, et al. Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer. Clin Oncol (R Coll Radiol). 2008;20:502–5.
Ortholan C, Hannoun-Levi JM, Ferrero JM, et al. Long-term results of adjuvant hypofractionated radiotherapy for breast cancer in elderly patients. Int J Radiat Oncol Biol Phys. 2005;61:154–62.
Algara M, Foro P, Reig A, Lacruz M, Auñón C, Valls A. Edad avanzada y neoplasia de mama. Utilidad del hipofraccionamiento. Resultados preliminares. Oncología. 1999;22(4):35–40.
Rostom AY, Pradhan DG, White WF. Once weekly irradiation in breast cancer. Int J Radiat Oncol Biol Phys. 1987;13:551–5.
Dragun AE, Quillo AR, Riley EC, et al. Clinical investigation: breast cancer a phase 2 trial of once-weekly hypofractionated breast irradiation: first report of acute toxicity, feasibility, and patient satisfaction. Int J Radiat Oncol Biol Phys. 2013;85(3):e123–8.
FAST Trialists Group, Agrawal RK, Alhasso A, Barret-Lee PJ, et al. First results of the randomised UK FAST trial of radiotherapy hypofractionation for treatment of early breast cancer (CRUKE/04/015). Radiother Oncol. 2011;100:93–100.
Brunt M, Haviland J, Sydenham M, et al. FAST phase III RCT of radiotherapy hypofractionation for treatment of early breast cancer: 10-year results (CRUKE/04/015). Int J Radiat Oncol Biol Phys. 2018;102(5):1603–4.
Sanz X, Algara M, Foro P, Reig A, Lozano J, Membrive I, Rodríguez N. Radioterapia hipofraccionada semanal en pacientes de edad avanzada con cancer de mama. Rev Senol Patol Mam. 2008;21(4):145–50.
This study has no received any funding
Conflict of interest
All authors declare they have no conflict of interest excepte Dr Algara that has received consulting honoraria from Sysmex and Aristo and speaking honoraria from Siemens and Roche.
All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
All patients signed an informed consent.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Zhao, M., Sanz, J., Rodríguez, N. et al. Weekly radiotherapy in elderly breast cancer patients: a comparison between two hypofractionation schedules. Clin Transl Oncol 23, 372–377 (2021). https://doi.org/10.1007/s12094-020-02430-7
- Breast cancer
- Elderly patients
- Weekly hypofractionation