Acute and Late Toxicity In Breast Cancer Patient That Received Hypofractionated Adjuvant Radiotherapy after Breast Conserving Surgery: A Case Report
Abstract
Introduction: Breast cancer is the most common female malignancy worldwide. Breastconserving surgery followed by adjuvant radiotherapy is a preferable treatment option. Hypofractionated radiotherapy is an attractive fractionation scheme because of its shorter treatment duration. This paper aims to report the short-term and long-term toxicity of hypofractionated radiotherapy in breast cancer patients at our institution. Case Presentation: A 58-year-old woman with right breast cancer T2N1M0 had undergone breast-conserving surgery with axilla lymph node dissection. This patient underwent adjuvant whole breast radiotherapy with a dose of 42.56 Gy in 16 fractions followed by tumor bed boost with a dose of 16 Gy in 8 fractions. After undergoing the fourth fraction of boost, she had hyperpigmentation on her radiation area (RTOG skin toxicity grade 1). At the 6-month follow-up, the hyperpigmentation still appeared. Until the 24-month follow-up, after she completed radiotherapy, there was no sign of tumor recurrence and toxicity.
Conclusion: Hypofractionated radiotherapy could be an option for breast cancer treatment that provides equivalent local control, survival, and side effects to conventional fractionation radiotherapy.
Keywords
DOI: 10.33371/ijoc.v14i4.741
Article Metrics
Abstract View: 784, 
PDF Download: 517
References
Kementrian Kesehatan RI. Buletin Jendela Data & Informasi Kesehatan: Situasi penyakit kanker [Internet]. 2015 [cited 2020 Jun 29]. Available from: https://pusdatin.kemkes.go.id/download.php?file=download/pusdatin/buletin/Buletin-SIK-2016.pdf.
International Agency for Research on Cancer. Cancer Today [Internet]. 2018 [cited 2020 Jun 29]. Available from: https://gco.iarc.fr/today/online-analysis-piev=2018&mode=cancer&mode_population=continents&population=900&populations=900&key=total&sex=0&cancer=39&type=0&statistic=5&prevalence=0&population_group=0&ages_group%5B%5D=0&ages_group%5B%5D=17&nb_items=7&group_cancer=1&include_nmsc=1&include_nmsc_other=1&half_pie=0&donut=0&population_group_globocan_id=
Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: Meta-analysis of individual patient data for 10 801 women in 17 randomised trials. Lancet. 2011;378(9804):1707–16.
Qi XS, White J, Li XA. Is α/β for breast cancer really low? Radiother Oncol. 2011;100(2):282–8.
Holloway CL, Panet-Raymond V, Olivotto I. Hypofractionation should be the new “standard” for radiation therapy after breast conserving surgery. Breast. 2010;19(3):163–7.
Smith BD, Bellon JR, Blitzblau R, et al. Radiation therapy for the whole breast : Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol. 2018;8(3):145-52.
Cox JD, Stetz JA, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys. 1995;31(5):1341–6.
Stuckey A. Breast Cancer. Clin Obstet Gynecol. 2011;54(1):96–102.
Agrawal RK, Aird EGA, Barrett JM, et al. A The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;9:331–41.
Agrawal RK, Aird EGA, Barrett JM, et al. The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet. 2008;371(9618):1098–107.
Whelan TJ, Pignol J-P, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med. 2010;362(6):513–20.
Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol. 2015;16(1):47–56.
Bartelink H, Horiot JC, Poortmans PM, et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-Year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25(22):3259–65.
Karasawa K, Banu AP, Tasbolat A, et al. A prospective international study on safety and efficacy of hypofractionated radiation therapy for post-operative breast cancer patients in asian countries. Int J Radiat Oncol. 2018;102(3):e577.
Osako T, Oguchi M, Kumada M, et al. Acute radiation dermatitis and pneumonitis in japanese breast cancer patients with whole breast hypofractionated radiotherapy compared to conventional radiotherapy. Jpn J Clin Oncol. 2008;38(5):334–8.
Owen JR, Ashton A, Bliss JM, et al. Effect of radiotherapy fraction size on tumour control in patients with early-stage breast cancer after local tumour excision: long-term results of a randomised trial. Lancet Oncol. 2006;7(6):467–71.
Parekh A, Dholakia AD, Zabranksy DJ, et al. Predictors of radiation-induced acute skin toxicity in breast cancer at a single institution: Role of fractionation and treatment volume. Adv Radiat Oncol. 2018;3(1):8–15.
Bray FN, Simmons BJ, Wolfson AH, Nouri K. Acute and chronic cutaneous reactions to ionizing radiation therapy. Dermatol Ther (Heidelb). 2016;6(2):185–206.
Donovan EM, Bleackley NJ, Evans PM, Reise SF. Dose-position and dose-volume histogram analysis of standard wedged and intensity modulated treatments in breast radiotherapy. Br J Radiol. 2002;75:967–73.
Donovan E, Bleakley N, Denholm E, Evans P, Gothard L, Hanson J, et al. Randomised trial of standard 2D radiotherapy ( RT ) versus intensity modulated radiotherapy ( IMRT ) in patients prescribed breast radiotherapy. Radiother Oncol. 2007;82:254–64.
Rose F De, Fogliata A, Franceschini D, Iftode C, Navarria P, Comito T, et al. Hypofractionation with simultaneous boost in breast cancer patients receiving adjuvant chemotherapy : A prospective evaluation of a case series and review of the literature. The Breast. 2018;42:31–7.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Email this article 
