Hypofractionated regional nodal irradiation for women with node-positive breast cancer
Menée à partir de données portant sur 257 patientes atteintes d'un cancer du sein avec envahissement ganglionnaire traité par chirurgie conservatrice ou radicale en combinaison ou non avec une chimiothérapie, un traitement hormonal et/ou un traitement anti-HER2 (durée médiane de suivi : 64 mois), cette étude évalue l'effet d'une radiothérapie hypofractionnée de l'ensemble du sein, du thorax et des régions ganglionnaires sur la survie des patientes et le contrôle locorégional de la maladie
Purpose : To evaluate the effect of hypofractionated radiotherapy of breast/chest wall and regional nodes on overall survival, disease free survival and locoregional control as well as treatment-related toxicity in patients with breast cancer and nodal involvement. Patients and methods : Two hundred and fifty-seven patients treated between October 2009 and June 2011 with hypofractionated locoregional radiotherapy (42 Gy in 15 fractions) were retrospectively reviewed, 51 (19.8%) after breast-conserving surgery and 206 (80.2%) after radical surgery. Patients treated with breast conserving surgery received a boost dose to the tumor bed (delivered by photons, electrons, or by interstitial HDR brachytherapy). Two hundred and fifty-six (99.6 %) patients underwent chemotherapy, 209 (81.3%) had hormonal treatment and 65 (25.3%) had anti-HER2 targeted therapy. Results : The median follow-up was 64 months (range, 11-88). The 5-year overall survival (OS), disease free survival (DFS), Locoregional recurrence (LRR)-free survival and distant metastasis (DM)-free survival were 86.6% , 84.4%, 93.9% and 83.1% respectively. In the multivariate analysis (MVA), lymph nodes ratio >65%, lymphovascular invasion and negative hormone receptor status predicted for OS, DSF and Distant metastasis. T3-4 stage was also associated with a worse DFS and DM. Finally, for LRR the independent prognostic factors on MVA were N2-3 stage and grade 3. Hyperpigmentation was observed in 19.2 %, telangiectasia in 12.3% and fibrosis in 30.7% of patients. Grade ≥ 2 lymphedema was recorded in 5.8% of cases. During the study follow-up, no cardiac or symptomatic pneumonitis were observed, neither were plexopathy or rib fractures. Conclusion : According to the findings from this retrospective study, HFRT seems to be an acceptable alternative for patients with breast cancer who need regional nodal irradiation. However, prospective randomized trials are necessary to confirm these preliminary results.