Abstract

Introduction: The standard radiotherapy fractionation in breast cancers practised in worldwide is 50Gy in 25 fractions. Some trials have tested the hypothesis that breast cancer is as sensitive to fraction size as the normal tissues of the breast and underlying rib cage and that a more effective strategy would be to deliver fewer, larger fractions to a lower total dose regimens (hypofractionation). The purpose of this study is to assess the tissue toxicity, quality of life and local recurrence of patients undergoing hypofractionated radiotherapy for early breast cancer.

Objectives

1. To assess the tissue toxicity of hypo fractionated radiotherapy for early breast cancer.
2. To assess the quality of life in patients on hypo fractionated radiotherapy for early breast cancer
3. To assess the local recurrence of patients on hypo fractionated radiotherapy for early breast cancer.

Methods: 42 Patients with invasive early breast cancer who had underwent mastectomy or breast conservation surgery and who had indications for post op RT were subjected to a fractionation schedule of 40 Gy in 15 fractions to the chest wall or breast. Planning was done with conventional techniques. Tissue toxicity and quality of life of the patients were assessed during RT and on further follow up. Findings were graded using RTOG toxicity scale and EORTC questionnaire.

Results: Most of the patients were in the age group of 51-60 years, with 59.5% of patients in post menopausal group. All patients had grade 1 skin reaction. Two patients developed grade 2 skin reaction and one patient showed grade 4 reaction. Grade 1 mucositis, as throat pain was present in 76.2 % of patients. There were no grade 2, grade 3, or grade 4 mucositis.  Grade1 lung toxicity was seen in 14.3% of patients during RT and 81% had moderate amount of arm edema during follow up. No patients had any cardiac or neurological symptoms and any local recurrence. Quality of life assessment showed worsening during RT which improved later on follow up. But shows decrease on comparison with pre RT status.

Conclusion: Adjuvant hypo fractionated radiotherapy after surgery to early breast cancer is generally well tolerated and is a viable alternative to the conventional fractionation with acceptable tissue toxicity, quality of life and local control. it provides a shorter treatment time and better patient compliance. This could prove especially useful in resource limited centres with high patient load.

Keywords: Hypofractionation – early-breast cancer – tissue  toxicity – quality of life-local recurrence.