Breast Cancer

MO 14 - Breast 3 - Techniques, Toxicities and Dosimetry

1171 - An Institutional Phase I/II Study to Evaluate Safety and Efficacy of High Dose Weekly Hypofractionated Palliative Breast Radiotherapy in Advanced Unresectable or Metastatic Breast Cancer

Tuesday, September 17
3:25 PM - 3:30 PM
Location: Room W186

An Institutional Phase I/II Study to Evaluate Safety and Efficacy of High Dose Weekly Hypofractionated Palliative Breast Radiotherapy in Advanced Unresectable or Metastatic Breast Cancer
K. P. Haresh, T. Arun, S. Gupta, S. Suhani, R. Prashad, K. V a, A. V. R, P. Gupta, D. Kumar, S. Kumar, N. Begum, B. Devnani, and G. K. Rath; All India Institute Of Medical Sciences, New Delhi, India

Purpose/Objective(s): Huge local tumor with ulceration is troublesome for advanced and metastatic breast cancer patients. Systemic therapy and palliative local RT yield minuscule local control. Local disease control is paramount for better quality of life in these patients with poor survival. We hypothesised that high dose hypo fractionated radiotherapy 40Gy in 5 fractions over 5 weeks will control the locally advanced disease. This study addresses the safety and efficacy of this novel approach.

Materials/Methods: Fifteen patients were enrolled. Primary objective was to assess the radiation toxicity using RTOG criteria and the secondary objective was to assess the clinical and radiological response by RECIST criteria at 3 months. Acute toxicities are defined as toxicities occurring during and till 3 months after radiotherapy. Surgically inoperable huge fungating fixed lumps or metastatic carcinoma breast with ECOG 1, 2 or 3 were eligible. CT scan of breast was done for all patients before the start of radiotherapy. Clinical findings of breast were documented on the day of planning. Patients were planned on supine breast board by parallel opposed tangential wedge fields for 40Gy in 5 fractions over 5 weeks; one fraction per week (8Gy/#). Care was taken to avoid the lung and heart from the radiation field. Acute toxicity was assessed weekly during radiotherapy then monthly for first three months after completion of radiotherapy.

Results: Out of 15 patients, 6 had left sided while 9 had right sided breast cancers. Two had surgically inoperable advanced disease while 13 were upfront metastatic. Clinically 9 patients had skin involvement (5 extensive peud orange, 1 ulceration and 1 satellite lesions) and 8 had lump fixed to chest wall before RT. The median size of the tumor before the start of Radiotherapy was 4.8 cm [2.3 – 11 cm]. The median follow-up was 7 months. 5 patients succumbed to death during follow up. Grade 2 skin toxicity was seen in 27%, 66% and 80% at the end of 3rd, 4th and 5th week. There were 3 (20%) grade 3 toxicities at end of radiotherapy and none before. No grade 4 dermatitis were seen. Grade 3 breast induration was 60%, 53%, 33%, 28%, and 28% at the end of RT, 1st month, 2nd month, 3rd month and at 6th month follow up. Grade 2 breast induration was 40%, 47%, 47%, 66% and 66% at the end of RT, 1st month, 2nd month, 3rd month and at 6th month follow up. Most of the breast induration subsides by the end of 2nd month post RT. All patients had resolution of skin lesions and achieved mobility post RT at 1st follow up. On clinical examination at 6 months, two patients had local complete response and rest had good partial response or stable disease. On response assessment with imaging 12 patients had local partial response, 3 patients had local stable disease.

Conclusion: This study is the first of its kind. This novel radiotherapy schedule is safe, feasible and effective with acceptable toxicity. None of the patients have local progressive disease. Longer follow up is needed to assess late toxicities of this schedule.

Author Disclosure: K. Haresh: None. T. Arun: None. S. Gupta: None. R. Prashad: None. K. V a: None.

Thimmarayappa Arun, MBBS

Disclosure:
Employment
All India Institute Of Medical Sciences

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1171 - An Institutional Phase I/II Study to Evaluate Safety and Efficacy of High Dose Weekly Hypofractionated Palliative Breast Radiotherapy in Advanced Unresectable or Metastatic Breast Cancer



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