Hypofractionated nodal radiation therapy for breast cancer was not associated with increased patient-reported arm or brachial plexopathy symptoms

Publication date: Available online 3 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Nelson Leong, Pauline T. Truong, Keith Tankel, Winkle Kwan, Lorna Weir, Ivo A. Olivotto
PurposeTo determine whether nodal radiation therapy (RT) for breast cancer using modest hypofractionation (HF) with 2.25-2.5 Gy/fraction (fx) was associated with increased patient-reported arm symptoms, compared with conventional fractionation (CF) ≤2 Gy/fx.Materials and MethodsTwo cancer registries were used to identify subjects who received CT-planned, nodal RT for pT1-3, pN0-2, M0 breast cancer from 2007-2010 at two cancer institutions. Following ethics approval, patients were mailed an explanatory letter and the Self-reported Arm Symptom Scale (SASS), a validated instrument with 8 questions about arm symptoms and 5 related to activities of daily living (ADL). Clinico-pathologic characteristics and SASS scores were compared between HF/CF cohorts using non-parametric analysis, chi-squared analysis and multivariate ordinal regression.Results800/1759 patients returned a completed survey (45.5%). 708 eligible cases formed the study cohort. 406 (57%) received HFRT (40 Gy/16fx, 45 Gy/20fx), and 302 (43%) received CFRT (45-50 Gy/25fx, 50.4 Gy/28fx). Median time interval post-RT was 5.7 years. 43% and 75% of patients received breast conserving surgery and chemotherapy respectively. 22% received breast boost RT, independent of fractionation. Median age at diagnosis was 59 years (HF) and 53 years (CF) (p<0.001). The mean numbers of excised (n=12) and involved (n=3) nodes were similar between fractionation cohorts (p=0.44), as were the mean sums of responses in arm symptoms (p=0.17) and ADL (p=0.85). HF patients reported lower rates of shoulder stiffness (p=0.04), trouble moving the arm (p=0.02), and ability to reach overhead (p<0.01) compared to the CF cohort. There was no difference in self-reported arm swelling or symptoms related to brachial plexopathy.ConclusionsNodal RT with hypofractionation was not associated with increased patient-reported arm symptoms or functional deficits compared to CF. Subjects treated with CF reported more disability in certain aspects of arm/shoulder function. These data support shorter fractionation utilization when regional nodes are within the therapeutic target.

Teaser

Among 708 women treated with CT-planned regional nodal radiation therapy (RT) for breast cancer, self-reported arm symptoms were similar or less debilitating following modestly hypofractionated (2.25-2.5 Gy/day) versus conventionally fractionated (≤ 2 Gy/day) RT at a median of 5.7 years after treatment.


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