الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 264 |  |  |
| | | from | 264 | | |
Abstract
Randomized clinical trials in patients with early-stage breast cancer have demonstrated that following breast-conserving surgery, adjuvant whole breast irradiation (WBI) lowers the relative risk of ipsilateral breast tumor recurrence (IBTR) by approximately 70% at 5 years and produces a 5% absolute improvement in 15-year overall survival.
Most of these studies used conventionally fractionated (CF) radiation schemes, such as 1.8–2.0 Gy per fraction for a total dose of 45–50 Gy in 25–28 daily fractions with or without a subsequent radiation boost to the tumor bed.
In the past several years, randomized clinical trials conducted in Canada and the United Kingdom have compared CF-WBI with HF-WBI as adjuvant therapy for surgically treated early-stage breast cancer with very encouraging results.
This study was done to compare conventional whole breast radiotherapy versus hypofractionated schedule. The primary outcome for this study was any local recurrence of invasive cancer in the treated breast. Secondary outcomes were radiation toxicities, cosmetic outcome assessment, disease relapse and death.
Between September 2007 and April 2010 we randomly treated 100 consecutive patients with operable invasive early stage breast cancer and negative axillary lymph nodes with external beam radiation therapy. Group I (50 patients) was assigned to 50 Gy in 25 fractions to the whole breast plus a boost dose to the tumor bed of 16 Gy in 8 fractions, while Group II patients were treated with hypofractionated schedule of 42.5 Gy in 16 fractions to the whole breast plus a boost of 10 Gy in 4 fractions.
With a median follow up of 21 months (range 12 – 44 months). The study showed no statistical significant differences between the two treatment groups as regards treatment toxicities, cosmetic outcome, local recurrence, disease relapse and mortality. Statistically significant predictors for local recurrence were patient age, tumor grade, and tumor size, while for disease relapse and mortality tumor grade and size were the statistically significant variables.
Conclusion: We conclude that hypofractionated radiotherapy schedule has a reasonably good feasibility with no differences when compared to the conventional radiotherapy arm in terms of all studied outcomes. At the moment this more convenient short schedule seems an acceptable alternative to the traditional radiotherapy regime. Longer follow-up is being arranged to confirm these results and to evaluate whether this schedule assures excellent local-regional disease control besides good tolerability. The hypofractionated schedule offers the advantage of reducing the total treatment time while guaranteeing acceptable late effects and local control endpoints. Furthermore, a reduction of such magnitude in treatment duration would possibly allow for a far more efficient use of healthcare resources.