Malik Deepika, Singh Ashok, Birajdar Manoj M, Vyas Virendra J
Radiation Oncology, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Ambala, IND.
Radiation Oncology, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND.
Cureus. 2022 Mar 25;14(3):e23497. doi: 10.7759/cureus.23497. eCollection 2022 Mar.
The international standard for post-operative radiotherapy for breast cancer delivers hypofractionated radiotherapy. However, many centers in India still follow the longer conventional schedule probably because of paucity of large prospective trials in Indian patients on the same and apprehension regarding tolerance of high dose per fraction in the said population. We aimed to test the feasibility of hypofractionation in our setting and compared the toxicities and the quality of life in patients receiving conventional and hypofractionated radiotherapy.
Eighty histopathologically proven women of non-metastatic carcinoma breast who underwent modified radical mastectomy were assigned to receive 50 Gray/25 fractions/five weeks or 40 Gray/15 fractions/three weeks. Patients were assessed for the following toxicities - radiation dermatitis, radiation pneumonitis, dysphagia, skin fibrosis, lymphedema, shoulder stiffness, and brachial plexopathy, during radiation and at treatment completion and then at first, third, and sixth-month follow-up. Health-related quality of life was assessed using the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) and breast cancer-specific quality of life questionnaire (QLQ-BR23) at treatment completion and then at first, third, and sixth-month follow-up.
We had a mean follow-up of 12.78 months. All the assessed toxicities and quality of life scores were comparable between the two arms at all time points of evaluation (p>0.05); 40 Gray in 15 fractions over three weeks is feasible and as safe as the five-week schedule with comparable quality of life. Hypofractionation can be practiced as a routine for post-mastectomy breast cancer patients as this shorter radiotherapy schedule is convenient and cheaper for the patients with no compromise on normal tissue toxicity or quality of life.
乳腺癌术后放疗的国际标准采用大分割放疗。然而，印度的许多中心仍采用疗程更长的传统放疗方案，这可能是因为针对印度患者的大型前瞻性试验较少，且担心该人群对每分次高剂量的耐受性。我们旨在测试在我们的环境中进行大分割放疗的可行性，并比较接受传统放疗和大分割放疗患者的毒性反应及生活质量。
80名经组织病理学证实为非转移性乳腺癌且接受改良根治性乳房切除术的女性被分配接受50格雷/25次分割/五周或40格雷/15次分割/三周的放疗。在放疗期间、治疗结束时以及随后的第1、3和6个月随访时，对患者进行以下毒性反应评估——放射性皮炎、放射性肺炎、吞咽困难、皮肤纤维化、淋巴水肿、肩部僵硬和臂丛神经病变。在治疗结束时以及随后的第1、3和6个月随访时，使用欧洲癌症研究与治疗组织核心生活质量问卷（EORTC QLQ-C30）和乳腺癌特异性生活质量问卷（QLQ-BR23）评估健康相关生活质量。
我们的平均随访时间为12.78个月。在所有评估时间点，两组之间所有评估的毒性反应和生活质量评分均具有可比性（p>0.05）；三周内15次分割给予40格雷是可行的，并且与五周方案一样安全，生活质量相当。大分割放疗可作为乳房切除术后乳腺癌患者的常规治疗方法，因为这种较短的放疗方案对患者来说既方便又便宜，且不会影响正常组织毒性或生活质量。
