Hypofractionated irradiation in elderly patients with breast cancer after breast conserving surgery and mastectomy : Analysis of 205 cases
Identifieur interne : 000082 ( France/Analysis ); précédent : 000081; suivant : 000083Hypofractionated irradiation in elderly patients with breast cancer after breast conserving surgery and mastectomy : Analysis of 205 cases
Auteurs : Mélanie Doré [France] ; Bruno Cutuli [France] ; Patrice Cellier [France] ; Loïc Campion [France] ; Magali Le Blanc [France]Source :
- Radiation Oncology (London, England) [ 1748-717X ] ; 2015.
Abstract
Several randomized trials and meta-analyses confirmed a wide benefit of radiotherapy (RT), both after breast conserving surgery (BCS) and mastectomy. However, many elderly women don't receive RT. Hypofractionated (HF) RT allows « simplified » and more accessible treatments with equivalent results to classic RT in three large randomized trials. However, there are few available data on HF-RT for nodal irradiation, as well as for the boost.
We evaluated patients treated for IBC by HF-RT between 2004 and 2012 in two regional cancer centres. We used an original scheme delivering 45 Gy in 15 fractions three times a week, both after BCS or mastectomy, with or without nodal irradiation. After BCS, a 9 Gy boost in 3 fractions was delivered. Local, regional and distant recurrences were assessed, as well as acute and late cutaneous, cardiac or pulmonary toxicities.
205 patients were analysed, 116 after BCS (57 %) and 89 after mastectomy (43 %). Median age was 81 years (range: 52-91); 44 % had axillary nodal involvement (pN+). The Nottingham Prognostic Index (NPI) scored 0, 1, 2 and 3 in 10 %, 27 %, 44 % and 19 % of the cases. A nodal HF-RT was delivered in 65 patients (32 %) and boost in 98 patients (84 % of BCS) by 9 Gy/3 fr scheme. Fifty (24 %) patients underwent chemotherapy and 156 (75 %) hormonal treatment.
With a 49-month median follow-up, 3/116 (2.6 %) patients and 4/89 (4.5 %) had local recurrence (LR) after BCS and mastectomy, respectively. The overall 5-year LR rate was 4.4 %. In univariate and multivariate analysis, LR risk factors were: high NPI (HR 5.46;
Our HF-RT scheme (with or without nodal irradiation) confirms in elderly patients the data from randomized trials, both after BCS or mastectomy. Toxicity seems very acceptable but requires a longer follow-up. A larger evaluation is still ongoing in several other centres in France.
Url:
DOI: 10.1186/s13014-015-0448-y
PubMed: 26238442
PubMed Central: 4554320
Affiliations:
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xml:lang="fr">France</country><wicri:regionArea>Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Nantes</wicri:regionArea><placeName><region type="region">Pays de la Loire</region><region type="old region">Pays de la Loire</region><settlement type="city">Nantes</settlement></placeName></affiliation></author><author><name sortKey="Cutuli, Bruno" sort="Cutuli, Bruno" uniqKey="Cutuli B" first="Bruno" last="Cutuli">Bruno Cutuli</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Radiation Oncology Department, Institut de Cancérologie de Courlancy, Reims, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Radiation Oncology Department, Institut de Cancérologie de Courlancy, Reims</wicri:regionArea><placeName><region type="region">Grand Est</region><region type="old region">Champagne-Ardenne</region><settlement type="city">Reims</settlement></placeName></affiliation></author><author><name sortKey="Cellier, Patrice" sort="Cellier, Patrice" uniqKey="Cellier P" first="Patrice" last="Cellier">Patrice Cellier</name><affiliation wicri:level="3"><nlm:aff id="Aff3">Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Angers, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Angers</wicri:regionArea><placeName><region type="region">Pays de la Loire</region><region type="old region">Pays de la Loire</region><settlement type="city">Angers</settlement></placeName></affiliation></author><author><name sortKey="Campion, Loic" sort="Campion, Loic" uniqKey="Campion L" first="Loïc" last="Campion">Loïc Campion</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Nantes, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Nantes</wicri:regionArea><placeName><region type="region">Pays de la Loire</region><region type="old region">Pays de la Loire</region><settlement type="city">Nantes</settlement></placeName></affiliation></author><author><name sortKey="Le Blanc, Magali" sort="Le Blanc, Magali" uniqKey="Le Blanc M" first="Magali" last="Le Blanc">Magali Le Blanc</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Nantes, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Radiation Oncology Department, Institut de Cancérologie de l’Ouest, Nantes</wicri:regionArea><placeName><region type="region">Pays de la Loire</region><region type="old region">Pays de la Loire</region><settlement type="city">Nantes</settlement></placeName></affiliation></author></analytic><series><title level="j">Radiation Oncology (London, England)</title><idno type="eISSN">1748-717X</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Several randomized trials and meta-analyses confirmed a wide benefit of radiotherapy (RT), both after breast conserving surgery (BCS) and mastectomy. However, many elderly women don't receive RT. Hypofractionated (HF) RT allows « simplified » and more accessible treatments with equivalent results to classic RT in three large randomized trials. However, there are few available data on HF-RT for nodal irradiation, as well as for the boost.</p></sec><sec><title>Methods</title><p>We evaluated patients treated for IBC by HF-RT between 2004 and 2012 in two regional cancer centres. We used an original scheme delivering 45 Gy in 15 fractions three times a week, both after BCS or mastectomy, with or without nodal irradiation. After BCS, a 9 Gy boost in 3 fractions was delivered. Local, regional and distant recurrences were assessed, as well as acute and late cutaneous, cardiac or pulmonary toxicities.</p></sec><sec><title>Results</title><p>205 patients were analysed, 116 after BCS (57 %) and 89 after mastectomy (43 %). Median age was 81 years (range: 52-91); 44 % had axillary nodal involvement (pN+). The Nottingham Prognostic Index (NPI) scored 0, 1, 2 and 3 in 10 %, 27 %, 44 % and 19 % of the cases. A nodal HF-RT was delivered in 65 patients (32 %) and boost in 98 patients (84 % of BCS) by 9 Gy/3 fr scheme. Fifty (24 %) patients underwent chemotherapy and 156 (75 %) hormonal treatment.</p><p>With a 49-month median follow-up, 3/116 (2.6 %) patients and 4/89 (4.5 %) had local recurrence (LR) after BCS and mastectomy, respectively. The overall 5-year LR rate was 4.4 %. In univariate and multivariate analysis, LR risk factors were: high NPI (HR 5.46; <italic>p</italic> = 0.028), and triple negative tumour (HR 9.78; <italic>p</italic> = 0.006). Only 8 (4.5 %) patients had grade III skin toxicity; 29 (14 %) late fibrosis and 16 (8 %) telangiectasia. No pulmonary or cardiac toxicity was observed.</p></sec><sec><title>Conclusion</title><p>Our HF-RT scheme (with or without nodal irradiation) confirms in elderly patients the data from randomized trials, both after BCS or mastectomy. Toxicity seems very acceptable but requires a longer follow-up. A larger evaluation is still ongoing in several other centres in France.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Biganzoli, L" uniqKey="Biganzoli L">L Biganzoli</name></author><author><name sortKey="Wildiers, H" uniqKey="Wildiers H">H Wildiers</name></author><author><name sortKey="Oakman, C" uniqKey="Oakman C">C Oakman</name></author><author><name sortKey="Marotti, L" uniqKey="Marotti L">L Marotti</name></author><author><name sortKey="Loibl, S" uniqKey="Loibl S">S Loibl</name></author><author><name sortKey="Kunkler, I" uniqKey="Kunkler I">I Kunkler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cutuli, B" uniqKey="Cutuli B">B Cutuli</name></author><author><name sortKey="Cottu, Ph" uniqKey="Cottu P">PH Cottu</name></author><author><name sortKey="Guastalla, Jp" uniqKey="Guastalla J">JP Guastalla</name></author><author><name sortKey="Mechin, H" uniqKey="Mechin H">H 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Bliss</name></author><author><name sortKey="Homewood, J" uniqKey="Homewood J">J Homewood</name></author><author><name sortKey="Harper, C" uniqKey="Harper C">C Harper</name></author><author><name sortKey="Hanson, J" uniqKey="Hanson J">J Hanson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cutuli, B" uniqKey="Cutuli B">B Cutuli</name></author><author><name sortKey="Fourquet, A" uniqKey="Fourquet A">A Fourquet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, Bd" uniqKey="Smith B">BD Smith</name></author><author><name sortKey="Bentzen, Sm" uniqKey="Bentzen S">SM Bentzen</name></author><author><name sortKey="Correa, Cr" uniqKey="Correa C">CR Correa</name></author><author><name sortKey="Hahn, Ca" uniqKey="Hahn C">CA Hahn</name></author><author><name sortKey="Hardenberg, Ph" uniqKey="Hardenberg P">PH Hardenberg</name></author><author><name sortKey="Ibbott, Gs" uniqKey="Ibbott G">GS Ibbott</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>France</li></country><region><li>Champagne-Ardenne</li><li>Grand Est</li><li>Pays de la Loire</li></region><settlement><li>Angers</li><li>Nantes</li><li>Reims</li></settlement></list><tree><country name="France"><region name="Pays de la Loire"><name sortKey="Dore, Melanie" sort="Dore, Melanie" uniqKey="Dore M" first="Mélanie" last="Doré">Mélanie Doré</name></region><name sortKey="Campion, Loic" sort="Campion, Loic" uniqKey="Campion L" first="Loïc" last="Campion">Loïc Campion</name><name sortKey="Cellier, Patrice" sort="Cellier, Patrice" uniqKey="Cellier P" first="Patrice" last="Cellier">Patrice Cellier</name><name sortKey="Cutuli, Bruno" sort="Cutuli, Bruno" uniqKey="Cutuli B" first="Bruno" last="Cutuli">Bruno Cutuli</name><name sortKey="Le Blanc, Magali" sort="Le Blanc, Magali" uniqKey="Le Blanc M" first="Magali" last="Le Blanc">Magali Le 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