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Hypofractionated whole-breast radiotherapy in large breast size patients: is it really a resolved issue?

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Abstract

The purpose of this study was to evaluate the impact of breast size on acute and late side effects in breast cancer (BC) patients treated with hypofractionated radiotherapy (Hypo-RT). In this study we analyzed patients over 50 years with a diagnosis of early BC, candidate for Hypo-RT after conservative surgery. Acute and late skin toxicities were evaluated in accordance with the RTOG scale. Multivariable logistic analysis was performed using dosimetric/anatomical factors resulted associated with toxicity outcome in univariable analysis. Among patients treated between 2009 and 2015, 425 had at least 5 years of follow-up. At RT end, acute skin toxicity ≥ G2 and edema ≥ G2 occurred in 88 (20.7%) and 4 (0.9%) patients, respectively. The multivariable analysis showed association of skin toxicity with boost administration (p < 0.01), treated skin area (TSA) receiving more than 20 Gy (p = 0.027) and breast volume receiving 105% of the prescription dose (V105%) (p = 0.016), but not breast size. At 5 years after RT, fibrosis ≥ G1 occurred in 89 (20.9%) patients and edema ≥ G1 in 36 (8.5%) patients. Fibrosis resulted associated with breast volume ≥ 1000 cm3 (p = 0.04) and hypertension (p = 0.04). As for edema, multivariable logistic analysis showed a correlation with hypertension and logarithm of age, but not with boost administration. Breast volume had an unclear impact (p = 0.055). A recurrent association was found between acute and late toxicities and breast V105%, which is correlated with breast size. This may suggest that a more homogenous RT technique may be preferred for patients with larger breast size.

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Author notes

  1. Anna Cavallo and Maria Chiara Magri have contributed equally to this work.

Authors and Affiliations

  1. Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Via Giacomo Venezian, 1, 23100, Milano, Italy

    Riccardo Ray Colciago, Angelo Vitullo, Eliana La Rocca, Carlotta Giandini, Riccardo Valdagni, Laura Lozza & Maria Carmen De Santis

  2. Department of Radiotherapy, Università Degli Studi di Milano Bicocca, Milan, Italy

    Riccardo Ray Colciago

  3. Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Anna Cavallo, Francesca Bonfantini & Emanuele Pignoli

  4. Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Maria Chiara Magri, Paolo Baili & Milena Sant

  5. Department of Oncology and Hemato-Oncology, Università Degli Studi di Milano, Milan, Italy

    Angelo Vitullo, Eliana La Rocca, Carlotta Giandini & Riccardo Valdagni

  6. Department of Applied Research and Technological Development (DRAST), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Serena Di Cosimo

  7. Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Riccardo Valdagni

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  1. Riccardo Ray Colciago
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Correspondence to Eliana La Rocca.

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The present study has been reviewed and approved by the Internal Review Board of the Department of Radiation Oncology 1 of National Cancer Institute, Milan, Italy.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Colciago, R.R., Cavallo, A., Magri, M.C. et al. Hypofractionated whole-breast radiotherapy in large breast size patients: is it really a resolved issue?. Med Oncol 38, 107 (2021). https://doi.org/10.1007/s12032-021-01550-6

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  • DOI: https://doi.org/10.1007/s12032-021-01550-6

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