Abstract

Background: Breast cancer is one of the most frequently diagnosed malignancy in women worldwide. A multimodality approach is usually preferred for treatment of all the patients for local regional and systemic control of the disease. In recent times, there has been a gradual improvement in radiotherapy delivery and has shifted from conventional to hypofractionated radiotherapy with equivocal results. This article highlights the acute toxicities in conventional and hypofractionated radiotherapy.

Aim: To study the acute toxicity in terms of skin reaction, dysphagia and arm oedema. Material and methods: This prospective study was conducted at the Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner. From Jan 2014 to Dec 2014; fifty patients of post-MRM carcinoma breast stage IIA-IIIA (pT1-3, pN1-2) were enrolled for the study.  Informed consent patients was taken. Arm A: 50 Gy / 25fractions, over 5weeks. Arm B: 40 Gy / 15 fractions, over 3 weeks.  Patients were kept supine with arm abducted to 90 degrees or higher and were treated with two field technique by using Co-60 energy source on Theratron 780C or Bhabhatron-II. Toxicity was documented according to CTCAE 3.0 version. Raw or cream Aloe-vera application to the irradiated skin was advised in every patient. P values of ˂0.05 were considered to be statistically significant.

Results: skin reactions observed at end of RT in 68% v/s 44% (P=0.023) and at 3 months, 12% v/s 4% (P=0.045). Grade 2 reactions were seen in 28% v/s 8% (P=0.0008), Grade 3 reactions were also significantly lower in study arm 4% v/s 12% (P=0.045).  At the end of RT, study arm had grade 1&2 dysphagia in 32% v/s 12% patients in control arm (P=0.002). At 1 month dysphagia observed in 16% patients in study arm v/s 4% in control arm (P=0.007).  No patient had grade 3 or higher dysphagia. At the end of RT, cosmetic appearance was equivocal.  But at 1 month, cosmetic appearance was significantly better in study arm 80% v/s 52% (P=0.014). 32% had moderate arm edema in control arm as compared to 28% in study arm (P value = 0.28).

Conclusion: Present study has proved it slightly better or equivocal with conventional fractionation for post-mastectomy irradiation in terms of tolerance. Thus hypo-fractionation schedule can be adopted as a standard form of treatment in post-mastectomy patients.

Keywords: Breast cancer, Hypofractionation, Acute toxicities, Radiotherapy.