Shu-Lian Wang1, Hui Fang1, Chen Hu2, Yong-Wen Song1, Wei-Hu Wang1, Jing Jin1, Yue-Ping Liu1, Hua Ren1, Juan Liu3, Gao-Feng Li4, Xiang-Hui Du5, Yu Tang1, Hao Jing1, Yu-Chao Ma1, Zhou Huang1, Bo Chen1, Yuan Tang1, Ning Li1, Ning-Ning Lu1, Shu-Nan Qi1, Yong Yang1, Guang-Yi Sun1, Xin-Fan Liu1, Ye-Xiong Li1. 1. State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. 2. Division of Biostatistics and Bioinformatics, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD. 3. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China. 4. Department of Radiation Oncology, Beijing Hospital, Beijing, China. 5. Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China.
Abstract
PURPOSE: No randomized trials have compared hypofractionated radiotherapy (HFRT) with conventional fractionated radiotherapy (CFRT) after breast-conserving surgery in the Asian population. This study aimed to determine whether a 3.5-week schedule of HFRT is noninferior to a standard 6-week schedule of CFRT in China. PATIENTS AND METHODS: Patients from 4 Chinese institutions who had undergone breast-conserving surgery and had T1-2N0-3 invasive breast cancers participated this study. Patients were randomly assigned (1:1) using a computer-generated central randomization schedule, without stratification, to receive whole-breast irradiation with or without nodal irradiation, followed by tumor-bed boost, either at a dose of 50 Gy in 25 fractions over 5 weeks with a boost of 10 Gy in five fractions over 1 week (CFRT) or 43.5 Gy in 15 fractions over 3 weeks with a boost of 8.7 Gy in three daily fractions (HFRT). The primary endpoint was 5-year local recurrence (LR), and a 5% margin of 5-year LR was used to establish noninferiority. RESULTS:Between August 2010 and November 2015, 734 patients were assigned to the HFRT (n = 368) orCFRT (n = 366) group. At a median follow-up of 73.5 months (interquartile range, 60.5-91.4 months), the 5-year cumulative incidence of LR was 1.2% in the HFRT group and 2.0% in the CFRT group (hazard ratio, 0.62; 95% CI, 0.20 to 1.88; P = .017 for noninferiority). There were no significant differences in acute and late toxicities, except that the HFRT group had less grade 2-3 acute skin toxicity than the CFRT group (P = .019). CONCLUSION:CFRT and HFRT with a tumor-bed boost may have similar low LR and toxicity.
RCT Entities:
PURPOSE: No randomized trials have compared hypofractionated radiotherapy (HFRT) with conventional fractionated radiotherapy (CFRT) after breast-conserving surgery in the Asian population. This study aimed to determine whether a 3.5-week schedule of HFRT is noninferior to a standard 6-week schedule of CFRT in China. PATIENTS AND METHODS: Patients from 4 Chinese institutions who had undergone breast-conserving surgery and had T1-2N0-3 invasive breast cancers participated this study. Patients were randomly assigned (1:1) using a computer-generated central randomization schedule, without stratification, to receive whole-breast irradiation with or without nodal irradiation, followed by tumor-bed boost, either at a dose of 50 Gy in 25 fractions over 5 weeks with a boost of 10 Gy in five fractions over 1 week (CFRT) or 43.5 Gy in 15 fractions over 3 weeks with a boost of 8.7 Gy in three daily fractions (HFRT). The primary endpoint was 5-year local recurrence (LR), and a 5% margin of 5-year LR was used to establish noninferiority. RESULTS: Between August 2010 and November 2015, 734 patients were assigned to the HFRT (n = 368) or CFRT (n = 366) group. At a median follow-up of 73.5 months (interquartile range, 60.5-91.4 months), the 5-year cumulative incidence of LR was 1.2% in the HFRT group and 2.0% in the CFRT group (hazard ratio, 0.62; 95% CI, 0.20 to 1.88; P = .017 for noninferiority). There were no significant differences in acute and late toxicities, except that the HFRT group had less grade 2-3 acute skin toxicity than the CFRT group (P = .019). CONCLUSION: CFRT and HFRT with a tumor-bed boost may have similar low LR and toxicity.
Authors: Reshma Jagsi; Kent A Griffith; Frank A Vicini; Eyad Abu-Isa; Derek Bergsma; Amit Bhatt; Joshua T Dilworth; Michael Dominello; Stephen Franklin; David K Heimburger; Isaac Kaufman; Paul G Kocheril; Annette E Kretzler; Peter Paximadis; Jeffrey D Radawski; Eleanor M Walker; Lori Pierce Journal: Int J Radiat Oncol Biol Phys Date: 2021-10-28 Impact factor: 7.038
Authors: Julia E Douglas; Suyu Liu; Junsheng Ma; Robert A Wolff; Shubham Pant; Anirban Maitra; Eric P Tamm; Priya Bhosale; Matthew H G Katz; Gauri R Varadhachary; Eugene J Koay Journal: BMC Cancer Date: 2022-01-03 Impact factor: 4.430