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Long‐term outcomes of patients with conserved breast cancer treated with adjuvant hypofractionated prone breast intensity‐modulated radiation therapy
Author(s) -
Gortman Aron M,
Aherne Noel J,
Amalaseelan Julan,
Last Andrew,
Westhuyzen Justin,
Chamberlain Lauren,
Shakespeare Thomas P
Publication year - 2020
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.13072
Subject(s) - medicine , breast cancer , radiation therapy , prone position , median follow up , dose fractionation , oncology , radiology , cancer , chemotherapy
New techniques for adjuvant radiation therapy after breast conservation include prone positioning, hypofractionation and intensity‐modulated radiation therapy (IMRT). Long‐term evaluations of this combination are lacking, and we report our own experience. Methods Patients with invasive breast cancer followed for a minimum 36 months post‐IMRT were eligible. Dose used was 40 Gray in 15 fractions over 3 weeks to the whole breast via forward‐planned prone, whole breast IMRT. A 10 Gy in 5 fraction supine boost was offered. Results Between January 2012 and January 2020, 2199 patients had breast conservation and adjuvant radiation: 489 received hypofractionated prone breast IMRT, with 155 eligible for our evaluation. Median follow‐up was 52 months. Median age was 62 (range 36–80), 78.7% were T1, 20.6% were T2, and 12.3% were node‐positive. Grade was 1 in 26.5%, 2 in 43.9% and 3 in 29.7%; 87.1% were oestrogen receptor positive, 3.2% were HER2 positive, and 11.0% were triple negative. 58.6% received a boost, 74.8% endocrine therapy and 32.3% chemotherapy. No patient developed local recurrence. One regional recurrence was successfully salvaged. Six patients (3.9%) developed metastases, and 1.9% died. Five‐year actuarial local recurrence‐free, regional recurrence‐free and breast cancer‐specific survival rates were 100.0%, 98.2% and 94.8%. Late grade 1 and 2 breast pain occurred in 20.0% and 1.3% of patients. Only 11.0% had new pain compared to pre‐radiation. No patient developed radiation‐induced pneumonitis, pulmonary fibrosis, rib fracture or cardiac toxicity. All patients scored cosmesis as ‘good’ or better. Conclusion Adjuvant hypofractionated prone breast IMRT has excellent locoregional control and minimal toxicity.