Retrospective Analysis of the Effect of Radiation Boost versus No Boost Using Hypofractionation Schedule on Breast Cancer Loco-Regional Recurrence

Ahmed Shama; Amr Abdelmoneim Mahmoud; Emad Sadqa

Ahmed Shama Assistant Lecturer of Oncology and Nuclear Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
Amr Abdelmoneim Mahmoud Lecturer of Oncology and Nuclear Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
Emad Sadqa Professor of Oncology and Nuclear Medicine Department, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt

Keywords: Radiation Boost, Hypofractionation Schedule, Breast Cancer, Recurrence

Abstract

Background: Radiation treatment to the preserved breast following breast-conserving surgery lowers the mortality risk from breast cancer and cuts the disease's recurrence rate in half. The aim of this work was to define the effectiveness and feasibility of two different hypo fractionation schedules in the adjuvant settings of non-metastatic breast cancer.

Methods: This study included 100 patients, aged ≥50 years old, who had breast conservative surgery or mastectomy, invasive breast cancer with p T1-3, p N0-2 and non-metastatic breast cancer verified by clinical evaluations and imaging (X-ray chest and ultrasound or CT scan chest and abdomen). Patients were randomized into two equal groups: Control arm: received standard 40.05 gray (2.67 Gy/ fx) over 15 fractions over 3 weeks with or without boost and experimental arm: received 26 Gray (5.2) over 5 fractions over 1.5 weeks using one of the offered regimens.

Results: Lymph vascular invasion (LVI), Adjuvant treatment, clinical target volume (CTV, level1, level 2 and level 3 were significantly lower in boost group than non-boost group (P<0.05). Supraclavicular nodes (SCV), ipsilateral lung v5, mean lung, mean heart, pigmentation and erythema were significantly lower in boost group than non-boost group (P<0.05). Skin toxicity, recurrence and distant recurrence were not significantly different between both groups. Overall survival (OS) was statistically lower in boost group than non-boost group (P<0.05).

Conclusions: Boost group have statically significant lower LVI, Adjuvant treatment, CTV, level1, level2 and level3, SCV nodes, ipsilateral lung V5, mean lung, and mean heart than non-boost group and complication of radiation after mastectomy of breast cancer are less pigmentation, erythema and OS while, recurrence and distant recurrence are indifferent to conventional surgery without post radiation.