Abhilash G. H1, Anil Kumar Dhull2, Rajeev Atri3, Rakesh Dhankhar4, Vivek Kaushal5
INTRODUCTION
Breast cancer is the most common cancer in women worldwide and a leading cause of cancer death in females and accounts for 1.8 million new cases and approximately 0.5 million deaths annually. Patients who present with locally advanced breast cancer (LABC) require multidisciplinary team approach that incorporates diagnostic imaging, surgery, chemotherapy and histopathological assessment, including molecular-based studies, radiation, and, if indicated, biologic and hormonal therapies. Hypofractionated radiation therapy following mastectomy has been used in many institutions for several decades and have demonstrated equivalent local control, cosmetic and normal tissues between 50 Gy in 25 fractions and various hypofractionated radiotherapy prescriptions employing 13-16 fractions. Evidence suggests that hypofractionated radiotherapy may also be safe and effective for regional nodal disease.
AIMS AND OBJECTIVES
To compare the local control and side effects of hypofractionated radiation therapy with conventional radiation therapy in post mastectomy carcinoma breast with stage II and III and to compare the tolerability and compliance of both schedules.
MATERIALS AND METHODS
The study was conducted on 60 histopathologically proven patients of carcinoma of breast, treated surgically with modified radical mastectomy. Group I patients were given external radiation to chest flap and drainage areas, a dose of 39 Gy/13 fractions/3.1 weeks, a daily dose 3 Gy for 13 fractions in 4 days a week schedule and Group II patients were given external radiation to chest flap and drainage areas, a dose of 50 Gy/25 fractions/5 weeks, to receive a daily dose 2 Gy for 25 fractions in a 5 days a week schedule.
RESULTS
The median age at presentation in Group I and II was 48 and 50 years respectively. Locoregional control after completion of radiotherapy in Group I vs. Group II was 26/30 (86.7%) vs. 27/30 (90%) respectively. Acute reactions and their grades in Group I and II were: Skin reactions, grade I-(21/30) 70% vs. (22/30) 73.3%, grade II-(7/30) 23.4% vs. (7/30) 23.4%, grade III-(1/30) 3.3% vs. (1/30)3.3%, grade IV-(1/30) 3.3% vs. nil; oesophageal reactions; grade I-(7/30) 23.3% vs. (12/30) 40%, grade II-(3/30) 10% vs. nil. All the late radiation reactions in Group I were higher than in Group II.
CONCLUSION
In this present study, almost similar results were seen in both the groups in terms of local control and side effects. However, hypofractionated schedules have shown same response in terms of tumour control and late normal tissue effects with the advantage of decreased workload, increased compliance and reduced cost of treatment, and can be considered as a reliable alternative in radiation treatment for post mastectomy breast cancer patients.
