ABSTRACT
BACKGROUND/AIM: Adjuvant radiotherapy (RT) for breast cancer can be associated with acute dermatitis (ARD) and pneumonitis (RP). Prevalence and risk factors were characterized. PATIENTS AND METHODS: This study included 489 breast cancer patients receiving adjuvant RT with conventional fractionation (CF) ± sequential or simultaneous integrated boost, or hypo-fractionation ± sequential boost. RT-regimen and 15 characteristics were investigated for grade ≥2 ARD and RP. RESULTS: Prevalence of grade ≥2 ARD and RP was 25.3% and 2.5%, respectively. On univariate analyses, ARD was significantly associated with CF and radiation boost (p<0.0001), age ≤60 years (p=0.008), Ki-67 ≥15% (p=0.012), and systemic treatment (p=0.002). On multivariate analysis, RT-regimen (p<0.0001) and age (p=0.009) were associated with ARD. Chronic inflammatory disease was significantly associated with RP on univariate (p=0.007) and multivariate (p=0.016) analyses. CONCLUSION: Risk factors for grade ≥2 ARD and RP were determined that may help identify patients who require closer monitoring during and after RT.
Subject(s)
Breast Neoplasms , Lung Neoplasms , Pneumonia , Radiation Pneumonitis , Radiodermatitis , Humans , Middle Aged , Female , Breast Neoplasms/radiotherapy , Breast Neoplasms/complications , Radiation Pneumonitis/diagnosis , Radiation Pneumonitis/epidemiology , Radiation Pneumonitis/etiology , Radiodermatitis/diagnosis , Radiodermatitis/epidemiology , Radiodermatitis/etiology , Dose Fractionation, Radiation , Lung Neoplasms/complicationsABSTRACT
BACKGROUND/AIM: Many breast cancer patients receive adjuvant radiotherapy. Tumor bed boost may reduce risk of local failure in high risk patients. We compared hypofractionated whole-breast irradiation (WBI) plus boost (HF+boost) and conventionally fractionated WBI plus boost (CF+boost). PATIENTS AND METHODS: One-hundred-and-twenty-eight patients receiving HF-WBI (40 Gy in 15 fractions) plus boost (group A) were matched to 127 patients receiving CF-WBI (50.4 Gy in 28 fractions) plus boost (group B), utilizing 10 characteristics. RESULTS: Grade ≥2 dermatitis rates were 16.4% in group A vs. 44.1% in group B (p<0.0001), and grade ≥2 pneumonitis rates were 1.6% vs. 2.4% (p=0.68). Four-year rates of local control, metastases-free survival, and overall survival were 100% vs. 99% (p=0.81), 98% vs. 100% (p=0.29), and 98% vs. 100% (p=0.17), respectively. CONCLUSION: HF+boost was associated with significantly less grade ≥2 dermatitis with similar disease control and survival.
Subject(s)
Breast Neoplasms , Dermatitis , Humans , Female , Breast Neoplasms/pathology , Mastectomy, Segmental , Neoplasm Staging , Breast/pathology , Radiotherapy, Adjuvant/adverse effects , Dermatitis/etiologyABSTRACT
BACKGROUND/AIM: During the last 10-15 years, alternative regimens for adjuvant radiotherapy (RT) of breast cancer have become more popular, including simultaneous integrated (SIB) instead of sequential boosts (SEB). We present long-term outcomes after conventional fractionation (CF) plus SIB vs. CF+SEB. PATIENTS AND METHODS: Forty-eight patients receiving CF+SIB (treatment time=5.5 weeks) were matched to 72 patients (control group) receiving CF+SEB (6.5 weeks) considering twelve characteristics. Both groups were compared for radiation dermatitis, pneumonitis, local control (LC), metastases-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: Rates of grade ≥2 dermatitis were 35.4% (CF+SIB) and 45.8% (CF+SEB), respectively (p=0.26), and rates of grade ≥2 pneumonitis 0% and 4.2%, respectively (p=0.27). Six-year LC, MFS, CSS, and OS rates were 100% vs. 93% (p=0.11), 97% vs. 100% (p=0.29), 100% vs. 100% (p=1.00), and 98% vs. 100% (p=0.23), respectively. CONCLUSION: CF+SIB was similar to CF+SEB in terms of toxicities and outcomes but reduces total treatment time by one week.
Subject(s)
Breast Neoplasms , Radiodermatitis , Radiotherapy, Intensity-Modulated , Humans , Female , Radiotherapy, Adjuvant/adverse effects , Radiotherapy, Intensity-Modulated/adverse effects , Breast , Radiotherapy Dosage , Radiodermatitis/etiologyABSTRACT
BACKGROUND/AIM: Pneumonitis is a serious complication after radiotherapy of breast cancer. This study aimed to identify its prevalence and potential risk factors. PATIENTS AND METHODS: A total of 606 patients irradiated following breast-conserving surgery or mastectomy were retrospectively analyzed. In patients developing pneumonitis, radiation and clinical parameters were investigated to identify potential risk factors. RESULTS: Eleven patients (1.8%) developed a pneumonitis grade ≥2. Mean doses to the ipsilateral lung were >7 Gy in 5 patients (45%). Of the other patients, 5 had a chronic inflammatory disease. Six patients (55%) had another malignancy (4 previous contralateral breast cancers, 1 previous ovarian and thyroid cancer, 1 synchronous carcinoma-in-situ (pTis) at the contralateral breast). Five patients (45%) received chemotherapy including taxanes and 4 patients (36%) received trastuzumab. CONCLUSION: The prevalence of pneumonitis was 1.8%. Potential risk factors included mean radiation dose to ipsilateral lung >7 Gy, systemic treatment with taxanes or trastuzumab, chronic inflammatory disease and history of another malignancy.