Icro Meattini1,2,3, Marta Scorsetti4,5, Fiorenza De Rose4,3, Maria Carmen De Santis6,3, Bruno Meduri7,8, Ciro Franzese4,5, Davide Franceschini4, Pierfrancesco Franco9,3, Nadia Pasinetti10,3, Valentina Lancellotta11,3, Patrizia Giacobazzi12, Eliana La Rocca6, Elisa D'Angelo12, Laura Lozza6, Lorenzo Livi1,2. 1. Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy. 2. Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy. 3. Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy. 4. Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy. 5. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy. 6. Radiotherapy Unit 1, Fondazione I.R.C.C.S Istituto Nazionale Tumori di Milano, Milano, Italy. 7. Radiation Oncology Unit, University Hospital of Modena, Via del pozzo71, 41124, Modena, Italy. brunomeduri@gmail.com. 8. Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy. brunomeduri@gmail.com. 9. Department of Oncology, University of Turin, Turin, Italy. 10. Radiation Oncology Service, ASST Valcamonica Esine and Brescia University, Brescia, Italy. 11. Dipartimento di Diagnostica per Immagini, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Radioterapia Oncologica ed Ematologia, Roma, Italia. 12. Radiation Oncology Unit, University Hospital of Modena, Via del pozzo71, 41124, Modena, Italy.
Abstract
BACKGROUND AND PURPOSE: Randomized trials confirmed the efficacy and the safety of hypofractionated whole breast irradiation (HF-WBI) in patients with early-stage breast cancer. However, the role of HF-WBI in patients with DCIS after breast conserving surgery has not yet been clearly established in prospective randomized trials. The aim of this study was to evaluate if HF-WBI can be considered comparable to conventionally fractionated (CF)-WBI in DCIS patients. MATERIALS AND METHODS: The analysis included DCIS patients from four Italian centers treated with CF-WBI 50 Gy/25 fractions or HFRT 40.5 Gy/15 fractions, without tumor bed boost. A propensity score matching (PSM) analysis was performed using a logistic regression that considered age, grading, presence of necrosis, resection margin status and adjuvant endocrine therapy. RESULTS: Five hundred twenty-seven patients was included (367 in the CF-WBI-group and 160 in the HR-WBI group). After 1:1 matching, 101 patients were allocated to the CF-WBI-group and 104 to the HF-WBI group. No correlation was observed between the type of RT schedule and LRFS (HR 1.68, 95% CI 0.82-3.45; p = 0.152). After PSM, no statistical difference was observed between the two RT group (HR 1.11, 95% CI 0.40-3.04; p = 0.833), with 3- and 5-years LRFS rates of 100% and 97.9% for CF-WBI and 95.6% and 94% for HF-WBI. CONCLUSION: A short course of radiation therapy seems to be comparable to CF-WBI in terms of clinical outcomes. These data support the use of hypofractionated schedules in DCIS patients, but considering the remaining uncertainties.
BACKGROUND AND PURPOSE: Randomized trials confirmed the efficacy and the safety of hypofractionated whole breast irradiation (HF-WBI) in patients with early-stage breast cancer. However, the role of HF-WBI in patients with DCIS after breast conserving surgery has not yet been clearly established in prospective randomized trials. The aim of this study was to evaluate if HF-WBI can be considered comparable to conventionally fractionated (CF)-WBI in DCIS patients. MATERIALS AND METHODS: The analysis included DCIS patients from four Italian centers treated with CF-WBI 50 Gy/25 fractions or HFRT 40.5 Gy/15 fractions, without tumor bed boost. A propensity score matching (PSM) analysis was performed using a logistic regression that considered age, grading, presence of necrosis, resection margin status and adjuvant endocrine therapy. RESULTS: Five hundred twenty-seven patients was included (367 in the CF-WBI-group and 160 in the HR-WBI group). After 1:1 matching, 101 patients were allocated to the CF-WBI-group and 104 to the HF-WBI group. No correlation was observed between the type of RT schedule and LRFS (HR 1.68, 95% CI 0.82-3.45; p = 0.152). After PSM, no statistical difference was observed between the two RT group (HR 1.11, 95% CI 0.40-3.04; p = 0.833), with 3- and 5-years LRFS rates of 100% and 97.9% for CF-WBI and 95.6% and 94% for HF-WBI. CONCLUSION: A short course of radiation therapy seems to be comparable to CF-WBI in terms of clinical outcomes. These data support the use of hypofractionated schedules in DCIS patients, but considering the remaining uncertainties.
Entities:
Keywords:
Breast cancer; Ductal carcinoma in situ; Hypofractionated radiotherapy; Multicenter study; Propensity score matching
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