Seven fractions to deliver partial breast irradiation: the toxicity is Low

Marco Trovo, Michele Avanzo, Lorenzo Vinante, Carlo Furlan, Francesco Fiorica, Tiziana Perin, Loredana Militello, Simon Spazzapan, Massimiliano Berretta, Rajesh Jena, Joseph Stancanello, Erica Piccoli, Mario Mileto, Elvia Micheli, Mario Roncadin, Samuele Massarut

To assess toxicity and clinical outcome, in breast cancer patients treated with external beam partial breast irradiation (PBI) consisting of 35 Gy in 7 daily fractions (5 Gy/fraction). Patients affected by early-stage breast cancer were enrolled in this phase II trial. Patients had to be 60 years old or over and treated with breast conservative surgery for early stage invasive carcinoma. Seventy-three patients were analyzed. Median follow-up was 40 months. The proposed schedule was well tolerated. No Grade 3 toxicity was documented. Late toxicity was assessable for all the treated patients. Two patients (2.7%) developed Grade 2 pain 6 months after PBI. Four patients (5%) developed asymptomatic fat necrosis. Grade 2 fibrosis was observed in 5 patients (6.7%). No correlation was found between early and late toxicity and the type of adjuvant systemic therapy (no therapy vs. hormonal therapy vs. chemotherapy). No statistical correlation between dosimetric parameters and toxicity was found. Patients who developed Grade 2 radiation fibrosis had not higher radiation volumes to the untreated normal breast than those without fibrosis. Cosmesis was judged good/excellent in the majority of the cases (93%). One patient relapsed locally, and one developed distant metastases, corresponding to a 5-year local control and distant metastases-free survival of 98% and 96.7%, respectively. 35 Gy in 7 daily fractions is an effective and well-tolerated regimen to deliver PBI.