Accelerated Hypofractionated Radiotherapy with Weekly Concomitant Boost versus Conventional Radiotherapy in the Treatment of Breast Cancer after Conservative Surgery

Abstract

Adjuvant radiotherapy in the breast cancer treatment considered as back bone of breast conserving management after surgery. So, Adapting new schedule of the appropriate radiotherapy based on large randomized trials with guaranty of local control, better toxicity profile, QOL and cost effectiveness is a fundamental issue. As the advances in radiobiology allowing for a more precise estimation of equivalent dosing; and advances in the delivery of RT that have resulted in substantially improved dose homogeneity in the target volume with minimizing the dose to surrounding structures, a large group of hypofractionated RT trials were conducted. The use of hypofractionated therapy is likely to continue to increase worldwide as treatment techniques become increasingly more sophisticated and as evidence supporting hypofractionated RT continues to mature with clearer definition of optimal candidates. In this context; this prospective study included 52 patients with breast cancer, underwent conserving surgery who presented to Clinical Oncology and Nuclear medicine Department, Ain Shams University Hospitals. This study took place during the period from October 2011 to October 2013. All eligible patients fulfilling the inclusion criteria and after pretreatment assessments, randomized by single blinding into two groups: Group 1: Patients treated with standard whole breast irradiation will receive a total dose of 50 Gy in 25 fractions, 2 Gy per day, 5 days a week. The boost of 16 Gy will be delivered in 8 fractions for all patients after completion of the 50 Gy, without interruption. All patients will receive one fraction per day, 5 fractions a week. Group 2: Patients treated with hypofractionated irradiation will receive a total dose of 39 Gy in 13 fractions in 3 weeks to the whole breast with weekly concomitant boost 1GY \F \week over 3 weeks with at least 6 hours gap between two fractions All patients were planned through conformal based planning that complies with ICRU50 and ICRU62 and based on RTOG planning guidelines.