A Prospective single arm study to assess the feasibility and tolerability of hypo fractionated post mastectomy radiotherapy in patients with carcinoma breast

Balu George, (2014) A Prospective single arm study to assess the feasibility and tolerability of hypo fractionated post mastectomy radiotherapy in patients with carcinoma breast. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION: Breast cancer is one disease, the management of which keeps evolving and continues to baffle the clinician from ages. The surge for refinement in treatment modalities of breast cancer is ever growing and it is one of the most extensively studied diseases. Being the commonest cancer among women in the developed world, tremendous amount of research has gone into understanding the biology of this disease and novel treatment approaches are being investigated across the world. Breast cancer is a disease with potential for systemic spread with high risk of local recurrence. Essentially, the treatment of invasive breast cancer has surgery and radiation therapy as the modes for local control of the disease and chemotherapy for addressing the systemic micrometastasis. Radiation therapy is inherent in the setting of breast conservation therapy. Modified radical mastectomy is followed up with radiation therapy to the chest wall, supraclavicular or the axillary region according to specific indications. OBJECTIVES: To study the tolerability of hypofractionated post- mastectomy radiotherapy in terms of acute toxicities, especially dermatitis. Feasibility in terms of target coverage and dose limits to organs at risk were studied. METHODS: A single arm prospective study was done on patients diagnosed to have carcinoma breast with indications for post mastectomy radiotherapy and are willing for 3D Conformal Radiotherapy. The dose delivered was 40Gy in 15 fractions to chest wall alone or chest wall and supraclavicular regions. Weekly clinically examinations were done to assess acute toxicities. DVH data were collected to study the influence of regions treated on CTV coverage, dose to organs at risk. Data entry was done in Micrsoft Excel and was analysed using SPSS 16.0. Frequencies and percentages were calculated for discrete variables. The association between the outcome variables was tested using Chi square test. RESULTS: Out of the 12 patients, only one developed Grade III dermatitis. None of the patients developed Grade IV toxicities. Patients tolerated the treatment well. It was noted that the median V10Gy (26.1 % vs 16.9 %, p value 0.003) and V12Gy (25.2 % vs 16.23 %, p value 0.003) for ipsilateral lung was significantly high when there was an addition of supraclavicular field. We conclude that hypofractionated radiotherapy is a tolerable treatment regimen. Obese, left sided breast cancer patients who require supraclavicular irradiation may benefit from IMRT. CONCLUSION: Hypofractionated post mastectomy irradiation was well tolerated by our patients in terms of acute toxicities. Patients completed treatment without any delay or treatment breaks. There were no significant toxicity upto six weeks post treatment. The rate and severity of acute side effects were comparable with conventional radiotherapy. Long term effects on the lung, heart and contralateral breast needs to be studied. Patients were very satisfied about the convenience of this shorter radiotherapy schedule. As far as feasibility was concerned, we conclude that Three Dimensional Radiotherapy based hypofractionation might not be feasible in all patients. There is a subset of patients who may benefit from IMRT. Obese patients, with left sided disease and who also require supraclavicular irradiation might benefit from IMRT. The fact that supraclavicular radiation has significantly contributed to the lung dose even in conformal radiotherapy, where in the volume is relatively small, further urges us to be cautious while planning the supraclavicular field conventionally.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Breast cancer, Post-mastectomy radiotherapy, Hypofractionation.
Subjects: MEDICAL > Radio Therapy
Depositing User: Subramani R
Date Deposited: 23 Mar 2020 15:30
Last Modified: 23 Mar 2020 15:30
URI: http://repository-tnmgrmu.ac.in/id/eprint/12419

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