الفهرس 
SurgeryOnly 14 pages are availabe for public view
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Abstract
Breast cancer constitutes a major part of any Oncology facility and a respectable percentage on the radiotherapy workload. Breast irradiation after lumpectomy is an integral component of breast-conserving therapy that reduces the local recurrence of breast cancer.
The optimal fractionation schedule for breast irradiation has not been uniformly accepted; hence many trials have attempted to compare the efficacy as well as the tolerability of shorter schedules to the conventional ones.
The present study included 61 patients with early breast cancer (stage I and II) referred to Oncology and Radiotherapy department, Ain Shams University hospitals after Breast conservative surgery (BCS).
The study population was randomly divided to 2 arms. Patients were randomly assigned to receive whole breast irradiation of 42.5 Gy in 16 fractions over 22 days (Group A= 29 patients, one was lost during the follow-up) or to receive whole breast irradiation of 50 Gy in 25 fractions over 35 days (Group B= 31 patients). A boost of 16 Gy was given to the lumpectomy area. Radiation therapy was delivered daily, from Sunday through Thursday. Equivalence in outcome between the 2 groups was the aim of this study.
All patients received appropriate systemic therapy accordingly and adjuvant chemotherapy was completed prior to commencement of radiotherapy.
The 2 groups were comparable as regards baseline characteristics and treatment received.
Treatment morbidities showed equivalence between the 2 groups for cardiac and dermatologic aspects. Cardiac morbidity failed to favour left sided subjects.
Pulmonary toxicity for group A in the acute phase was more than that observed for group B, however this failed to reach statistical significance.
The incidence of arm lymphoedema was similar between both groups, and the delivery of regional radiation was not associated with it.
A satisfactory cosmetic score in 72.4% and 74.2% of patients in groups A and B respectively was achieved.
Local recurrence rates were 6.9% and 9.7% for groups A and B respectively. Five cases endured distant metastasis, 3 in group A and 2 in group B.
As regards disease free survival 82.8% vs. 83.9% were found for groups A and B respectively.
Machine capacity was almost doubled with patients in group A as compared to their conventional counterparts in group B. A formal cost analysis was not done but a rough estimate in the order of a 17% reduction in treatment cost was found.
Despite the limiting constraints of adequate follow- up time and number of patients, a shorter hypofractionated regimen seemed to be equivalent to the standard conventional fractionated schedule in early breast cancer. The main priority now would be to exclude as much of the heart as possible. Its adoption would definitely alleviate the strain on our already limited resources