A shorter fractionation schedule for postlumpectomy breast cancer patients

Shelley, Wendy; Brundage, Michael; Hayter, Charles; Paszat, Lawrence; Zhou, Sam; Mackillop, William

doi:10.1016/S0360-3016(00)00567-8

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 47, Issue 5 , Pages 1219-1228, 15 July 2000

A shorter fractionation schedule for postlumpectomy breast cancer patients☆

Preliminary results of this work were presented in part at the Royal College of Physicians and Surgeons of Canada Annual Meeting (Canadian Association of Radiation Oncology), Toronto, Ontario, September 1998.

Wendy Shelley, M.D.
- The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
- Reprint requests to: Dr. W. E. Shelley, Kingston Regional Cancer Centre, 25 King Street West, Kingston, Ontario K7L 5P9, Canada
Michael Brundage, M.D.
- The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
Charles Hayter, M.D.
- The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
Lawrence Paszat, M.D.
- The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
Sam Zhou (M.A.)
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
William Mackillop, M.D.
- The Radiation Oncology Research Unit, Kingston Regional Cancer Centre, Cancer Care Ontario, Kingston, Ontario, Canada
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada

Accepted 3 September 1999.

Abstract

Purpose: The purpose of this retrospective review was to determine the effectiveness of 40 Gy in 16 daily fractions in preventing local recurrence in postlumpectomy invasive breast cancer patients whose margins of resection were clear of tumor by at least 2 mm.

Methods: Between September 1989 and December 1993, 294 breasts were treated with this regimen. The entire breast was treated, using a tangential parallel pair, with wedges as necessary, to a dose of 40 Gy in 16 daily fractions. No additional boost was given. The median duration of follow-up of surviving patients is 5.5 years. Recently, the patients’ assessment of the cosmetic outcome of their treatment was obtained, using a mailed questionnaire.

Results: The 5-year actuarial breast-relapse rate was 3.5%, with an overall 5-year survival and disease-specific survival of 87.8% and 92.1%, respectively. In response to the cosmesis questionnaire, 77% of patients stated they were either extremely or very satisfied with the overall appearance of the breast, 19.5% moderately satisfied, and 3.5% either slightly or not at all satisfied. The corresponding responses for overall level of comfort of the breast were 79%, 16.5%, and 4.5% respectively.

Conclusion: This regimen is very effective at preventing recurrent breast cancer in this group of patients, and it provides a high level of patient satisfaction with cosmetic outcome. Its short duration offers the added advantage of a more efficient use of resources and greater patient convenience.

Keywords: Breast cancer, Lumpectomy, Fractionation schedule, Radiation therapy