A Phase II Trial of Once Weekly Hypofractionated Breast Irradiation for Early Stage Breast Cancer

Overview

Journal Ann Surg Oncol

Publisher Springer

Specialty Oncology

Date 2021 Mar 19

PMID 33738712

Citations 2

Authors

Harriet Eldredge-Hindy

Jianmin Pan

Shesh N Rai

Leonid B Reshko

Anthony Dragun

Elizabeth C Riley

Kelly M McMasters

Nicolas Ajkay

Affiliations

Soon will be listed here.

Abstract

Purpose: To report an interim analysis of a phase II trial of once weekly, hypofractionated breast irradiation (WH-WBI) following breast conserving surgery (BCS).

Methods: Patients had stage 0-II breast cancer treated with breast BCS with negative margins. WH-WBI was 28.5 or 30Gy delivered to the whole breast using tangential beams with no elective coverage of lymph nodes. The primary endpoint was ipsilateral breast tumor recurrence (IBTR). Secondary endpoints were distant disease-free survival (DDFS), recurrence free survival (RFS), overall survival (OS), adverse events and cosmesis.

Results: From 2011 to 2015, 158 patients received WH-WBI. Median follow up was 4.4 years (range 0.2-8.1). Stage distribution was DCIS 22%; invasive pN0 68%; invasive pN1 10%. 80 patients received 30 Gy and 78 received 28.5 Gy with median follow up times of 5.6 and 3.7 years, respectively. There were 5 IBTR events, all in the 30 Gy group. The 5- and 7- year risks of IBRT for all patients were 2.2% (95% CI 0.6-5.8) and 6.0% (95% CI 1.1-17.2), respectively. The 7-year rates of DDFS, RFS, and OS were 96.3%, 91.5% and 89.8%, respectively. Improvement in IBTR-free time was seen in DCIS, lobular histology, low grade tumors, Her2 negative tumors and 28.5 Gy dose (all p < 0.0001).

Conclusions: Disease-specific outcomes after WH-WBI are favorable and parallel those seen with conventional radiation techniques for stage 0-II breast cancer.

Citing Articles

Pencil Beam Scanning Bragg Peak FLASH Technique for Ultra-High Dose Rate Intensity-Modulated Proton Therapy in Early-Stage Breast Cancer Treatment.

Lattery G, Kaulfers T, Cheng C, Zhao X, Selvaraj B, Lin H Cancers (Basel). 2023; 15(18).

PMID: 37760528 PMC: 10527307. DOI: 10.3390/cancers15184560.

Implementation of External Beam Five-Fraction Adjuvant Breast Irradiation in a US Center.

Eckstein J, Taylor P, Zheng R, Lee L, Chen W, Potters L Cancers (Basel). 2022; 14(6).

PMID: 35326707 PMC: 8945963. DOI: 10.3390/cancers14061556.

References

Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A . Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002; 347(16):1227-32. DOI: 10.1056/NEJMoa020989. View

Fisher B, Anderson S, Bryant J, Margolese R, Deutsch M, Fisher E . 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(16):1233-41. DOI: 10.1056/NEJMoa022152. View

Poggi M, Danforth D, Sciuto L, Smith S, Steinberg S, Liewehr D . Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer. 2003; 98(4):697-702. DOI: 10.1002/cncr.11580. View

Ganz P, Schag A, Lee J, Polinsky M, Tan S . Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?. Cancer. 1992; 69(7):1729-38. DOI: 10.1002/1097-0142(19920401)69:7<1729::aid-cncr2820690714>3.0.co;2-d. View

Janni W, Rjosk D, Dimpfl T, Haertl K, Strobl B, Hepp F . Quality of life influenced by primary surgical treatment for stage I-III breast cancer-long-term follow-up of a matched-pair analysis. Ann Surg Oncol. 2001; 8(6):542-8. DOI: 10.1007/s10434-001-0542-2. View

Curran D, van Dongen J, Aaronson N, Kiebert G, Fentiman I, Mignolet F . Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative.... Eur J Cancer. 1998; 34(3):307-14. DOI: 10.1016/s0959-8049(97)00312-2. View

Jagsi R, Li Y, Morrow M, Janz N, Alderman A, Graff J . Patient-reported Quality of Life and Satisfaction With Cosmetic Outcomes After Breast Conservation and Mastectomy With and Without Reconstruction: Results of a Survey of Breast Cancer Survivors. Ann Surg. 2015; 261(6):1198-206. PMC: 4512928. DOI: 10.1097/SLA.0000000000000908. View

Kunkler I, Williams L, Jack W, Cameron D, Dixon J . Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015; 16(3):266-73. DOI: 10.1016/S1470-2045(14)71221-5. View

Hughes K, Schnaper L, R Bellon J, Cirrincione C, Berry D, McCormick B . Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013; 31(19):2382-7. PMC: 3691356. DOI: 10.1200/JCO.2012.45.2615. View

10.

McCormick B, Winter K, Hudis C, Kuerer H, Rakovitch E, Smith B . RTOG 9804: a prospective randomized trial for good-risk ductal carcinoma in situ comparing radiotherapy with observation. J Clin Oncol. 2015; 33(7):709-15. PMC: 4334775. DOI: 10.1200/JCO.2014.57.9029. View

11.

Solin L, Gray R, Hughes L, Wood W, Lowen M, Badve S . Surgical Excision Without Radiation for Ductal Carcinoma in Situ of the Breast: 12-Year Results From the ECOG-ACRIN E5194 Study. J Clin Oncol. 2015; 33(33):3938-44. PMC: 4652014. DOI: 10.1200/JCO.2015.60.8588. View

12.

Freedman R, He Y, Winer E, Keating N . Trends in racial and age disparities in definitive local therapy of early-stage breast cancer. J Clin Oncol. 2008; 27(5):713-9. DOI: 10.1200/JCO.2008.17.9234. View

13.

Smith G, Shih Y, Xu Y, Giordano S, Smith B, Perkins G . Racial disparities in the use of radiotherapy after breast-conserving surgery: a national Medicare study. Cancer. 2009; 116(3):734-41. PMC: 6130199. DOI: 10.1002/cncr.24741. View

14.

Hampton T . Studies address racial and geographic disparities in breast cancer treatment. JAMA. 2008; 300(14):1641. DOI: 10.1001/jama.300.14.1641. View

15.

Haggstrom D, Quale C, Smith-Bindman R . Differences in the quality of breast cancer care among vulnerable populations. Cancer. 2005; 104(11):2347-58. DOI: 10.1002/cncr.21443. View

16.

Hershman D, Buono D, McBride R, Tsai W, Joseph K, Grann V . Surgeon characteristics and receipt of adjuvant radiotherapy in women with breast cancer. J Natl Cancer Inst. 2008; 100(3):199-206. DOI: 10.1093/jnci/djm320. View

17.

Schroen A, Brenin D, Kelly M, Knaus W, Slingluff Jr C . Impact of patient distance to radiation therapy on mastectomy use in early-stage breast cancer patients. J Clin Oncol. 2005; 23(28):7074-80. DOI: 10.1200/JCO.2005.06.032. View

18.

Gold H, Do H, Dick A . Correlates and effect of suboptimal radiotherapy in women with ductal carcinoma in situ or early invasive breast cancer. Cancer. 2008; 113(11):3108-15. DOI: 10.1002/cncr.23923. View

19.

Jagsi R, Abrahamse P, Morrow M, Hawley S, Griggs J, Graff J . Patterns and correlates of adjuvant radiotherapy receipt after lumpectomy and after mastectomy for breast cancer. J Clin Oncol. 2010; 28(14):2396-403. PMC: 2881720. DOI: 10.1200/JCO.2009.26.8433. View

20.

Buchholz T, Theriault R, Niland J, Hughes M, Ottesen R, Edge S . The use of radiation as a component of breast conservation therapy in National Comprehensive Cancer Network Centers. J Clin Oncol. 2006; 24(3):361-9. DOI: 10.1200/JCO.2005.02.3127. View