Breast Cancer

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TU_12_3435 - The Impact of Chemotherapy on Toxicity and Cosmetic Outcome in Patients Receiving Hypofractionated Whole Breast Irradiation

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

The Impact of Chemotherapy on Toxicity and Cosmetic Outcome in Patients Receiving Hypofractionated Whole Breast Irradiation
J. Spann1, H. Ye2, K. Marvin2, M. S. Jawad2, P. Y. Chen2, G. S. Gustafson3, and J. T. Dilworth4; 1Oakland University William Beaumont School of Medicine, Rochester, MI, 2Beaumont Health (Department of Radiation Oncology), Royal Oak, MI, 3Beaumont Health System, Sterling Heights, MI, 4Dept. of Radiation Oncology, Beaumont Health, Royal Oak, MI

Purpose/Objective(s): 2011 ASTRO consensus guidelines suggest appropriateness criteria for the use of hypofractionated whole breast irradiation (H-WBI) based on subsets of patients well represented on randomized trials that compared H-WBI with conventionally fractionated regimens. These subsets included patients ≥50 years of age, patients with pT1-2/pN0 disease, patients whose radiation treatment plans maintained dose heterogeneity within ~7%, and patients who did not receive adjuvant systemic chemotherapy (CHT). We explored the impact of CHT on the toxicity and cosmetic outcomes of women with early stage breast cancer receiving H-WBI following breast conserving surgery.

Materials/Methods: In this IRB-approved study, we reviewed 292 consecutive patients who received H-WBI (42.56 Gy/16 fractions) with a surgical cavity boost (10-10.64 Gy/4 fractions) and had information regarding the use of CHT. Forty-nine patients (17%) out of the entire cohort received CHT. Acute (occurring within 6 weeks of H-WBI) and chronic (occurring 6 weeks after H-WBI) toxicities were assessed using the Common Terminology Criteria for Adverse Events v3; cosmetic score was determined using the Harvard scale. We performed a matched-pair analysis of patients with available toxicity data, using the following criteria: age (±5 years), breast size (±150 cc), and personal history of smoking (Y/N), diabetes (Y/N), and hypertension (Y/N). We compared clinical endpoints between 25 patients who did not receive CHT and 25 matched patients who received CHT.

Results: The no CHT and CHT groups were balanced with respect to mean follow up time (1.8 and 1.4 years, respectively, p=0.08), pathological nodal stage, receipt of hormonal therapy, and boost dose, in addition to all match criteria. As expected, compared to the no CHT group, the CHT group had higher T stage (32%/48%/16% vs. 4%/76%/20% with pDCIS/pT1/pT2, respectively, p=0.02) and more patients who received Herceptin (0% vs. 28%, p=0.01). There were similar rates of grade 2 or greater acute toxicities, including dermatitis (0% vs 0%), hyperpigmentation (20% vs 24%, p=0.73), breast pain (4% vs 12%, p=0.3), and edema (4% vs 8%, p=0.6) and a similar rate of an excellent/good early cosmetic outcome (100% vs. 92%, p=0.16). There were also similar rates of grade 2 or higher chronic toxicities, including dermatitis (0% vs. 0%), hyperpigmentation (0% vs 0%), breast pain (0% vs. 6%, p=0.33), edema (0% vs. 7%, p=0.31), fibrosis (0% vs 0%), and telangiectasia (0% vs 0%) and a similar rate of an excellent/good late cosmetic outcome (100% vs. 88%, p=0.16).

Conclusion: H-WBI appears to be well tolerated, even in patients receiving systemic chemotherapy. A larger cohort may detect subtle differences in the rates of toxicities and good/excellent cosmetic outcomes when comparing patients who receive CHT to those who do not. Further studies confirming the safety of H-WBI in patients who receive CHT is warranted.

Author Disclosure: J. Spann: None. H. Ye: None. K. Marvin: None. M.S. Jawad: None. P.Y. Chen: Stock; Greater Michigan Gamma Knife (GMGK). G.S. Gustafson: None. J.T. Dilworth: None.

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