Apar Gupta1, Atif J Khan2, Nikhil Yegya-Raman1, Mutlay Sayan1, Stuti Ahlawat3, Nisha Ohri1, Sharad Goyal4, Dirk F Moore5, Firas Eladoumikdachi1, Deborah Toppmeyer1, Bruce G Haffty6. 1. Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. 2. Memorial Sloan Kettering Cancer Center, New York, New York. 3. MD Anderson Cancer Center at Cooper, Camden, New Jersey. 4. George Washington University Hospital, Washington, DC. 5. Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey; Rutgers School of Public Health, Piscataway, New Jersey. 6. Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey. Electronic address: hafftybg@cinj.rutgers.edu.
Abstract
PURPOSE: To report 5-year outcomes of a phase 2 trial of hypofractionated whole breast irradiation (HF-WBI) completed in 3 weeks, inclusive of a sequential boost. METHODS AND MATERIALS: Women with stage 0-IIIA breast cancer (ductal carcinoma in situ through T2N2a) were enrolled on a prospective, phase 2 trial of accelerated HF-WBI. We delivered a whole breast dose of 36.63 Gy in 11 fractions of 3.33 Gy, with an equivalent dose to the regional nodes when indicated, followed by a tumor bed boost of 13.32 Gy in 4 fractions of 3.33 Gy over a total of 15 treatment days. The primary endpoint was locoregional control; secondary endpoints included acute/late toxicity and physician-assessed and patient-reported breast cosmesis. RESULTS: Between 2009 and 2017, we enrolled 150 patients, of whom 146 received the protocol treatment. Median age was 54 years (range, 33-82) and median follow-up was 62 months. Patients with higher-risk disease comprised 59% of the cohort, including features such as young age (33% ≤50 years), positive nodes (13%), triple-negative disease (11%), and treatment with regional nodal irradiation (11%) and/or neoadjuvant/adjuvant chemotherapy (36%). Five-year estimated locoregional and distant control were 97.7% (95% confidence interval [CI], 93.0%-99.3%) and 97.9% (95% CI, 93.6%-99.3%), respectively. Five-year breast cancer-specific and overall survival were 99.2% (95% CI, 94.6%-99.9%) and 97.3% (95% CI, 91.9%-99.1%), respectively. Acute/late grade 2 and 3 toxicities were observed in 30%/10% and 1%/3% of patients, respectively. There were no grade 4 or 5 toxicities. Physicians assessed breast cosmesis as good or excellent in 95% of patients; 85% of patients self-reported slight to no difference between the treated and untreated breast. CONCLUSIONS: Our phase 2 trial offers one of the shortest courses of HF-WBI; at 5 years of follow-up there continues to be excellent locoregional control and low toxicity with favorable cosmetic outcomes in a heterogeneous cohort of patients.
PURPOSE: To report 5-year outcomes of a phase 2 trial of hypofractionated whole breast irradiation (HF-WBI) completed in 3 weeks, inclusive of a sequential boost. METHODS AND MATERIALS: Women with stage 0-IIIA breast cancer (ductal carcinoma in situ through T2N2a) were enrolled on a prospective, phase 2 trial of accelerated HF-WBI. We delivered a whole breast dose of 36.63 Gy in 11 fractions of 3.33 Gy, with an equivalent dose to the regional nodes when indicated, followed by a tumor bed boost of 13.32 Gy in 4 fractions of 3.33 Gy over a total of 15 treatment days. The primary endpoint was locoregional control; secondary endpoints included acute/late toxicity and physician-assessed and patient-reported breast cosmesis. RESULTS: Between 2009 and 2017, we enrolled 150 patients, of whom 146 received the protocol treatment. Median age was 54 years (range, 33-82) and median follow-up was 62 months. Patients with higher-risk disease comprised 59% of the cohort, including features such as young age (33% ≤50 years), positive nodes (13%), triple-negative disease (11%), and treatment with regional nodal irradiation (11%) and/or neoadjuvant/adjuvant chemotherapy (36%). Five-year estimated locoregional and distant control were 97.7% (95% confidence interval [CI], 93.0%-99.3%) and 97.9% (95% CI, 93.6%-99.3%), respectively. Five-year breast cancer-specific and overall survival were 99.2% (95% CI, 94.6%-99.9%) and 97.3% (95% CI, 91.9%-99.1%), respectively. Acute/late grade 2 and 3 toxicities were observed in 30%/10% and 1%/3% of patients, respectively. There were no grade 4 or 5 toxicities. Physicians assessed breast cosmesis as good or excellent in 95% of patients; 85% of patients self-reported slight to no difference between the treated and untreated breast. CONCLUSIONS: Our phase 2 trial offers one of the shortest courses of HF-WBI; at 5 years of follow-up there continues to be excellent locoregional control and low toxicity with favorable cosmetic outcomes in a heterogeneous cohort of patients.
Authors: J López-Torrecilla; D González Sanchis; D Granero Cabañero; E García Miragall; P Almendros Blanco; A Hernandez Machancoses; L Brualla González; J Pastor Peidro; J C Gordo Partearroyo; J Rosello Ferrando Journal: Clin Transl Oncol Date: 2021-02-14 Impact factor: 3.405
Authors: Majd Kayali; Joseph Abi Jaoude; Paul Ramia; Hazem Assi; Fady Geara; Philip Poortmans; Youssef H Zeidan Journal: Ecancermedicalscience Date: 2021-03-01
Authors: Raluca Stoian; Thalia Erbes; Constantinos Zamboglou; Jutta Scholber; Mark Gainey; Ilias Sachpazidis; Erik Haehl; Simon K B Spohn; Vivek Verma; David Krug; Alexander Rühle; Ingolf Juhasz-Böss; Anca-Ligia Grosu; Nils H Nicolay; Tanja Sprave Journal: Strahlenther Onkol Date: 2021-04-30 Impact factor: 3.621