Ultrahypofractionated Radiotherapy in Early Breast Carcinoma-A Tertiary Cancer Centre Experience

Abstract AIM: Carcinoma breast is a major public health problem today being the most commonly occurring cancer in women and second most common cancer worldwide. Conventional fractionation regimen for adjuvant radiotherapy was a total dose of 45 to 50 Gy in 25 fractions or daily doses of 1.8 Gy to 2 Gy, patients were treated from Monday to Friday for a total duration of treatment being five weeks. With the introduction of UK START trials (START A and START B), hypofractionated radiotherapy schedules came into practice, thus shortening the treatment period to three weeks. In 2020, the five year results of ultra hypofractionated radiotherapy for 1 week versus 3 weeks (FAST FORWARD trial) were published. The multicentre, randomised phase three trial proved non inferiority of 26Gy in 5 fractions schedule compared to the standard 40Gy in 15 fractions schedule in terms of local control and normal tissue toxicity for adjuvant radiotherapy in early breast cancer patients.The aim of our study is to highlight the feasibility of ultrahypofractionated radiotherapy in Indian scenario with respect to tumour control and normal tissue toxicity. PATIENTS AND METHODS: The data of 50 female patients with early breast cancer (Stage I & II) treated in our hospital from April 2022 to December 2023 were analysed. The median age of the patients was 59years (30-86). 54% of the patients were left sided and 46% of the patients were right sided cancers. 74% of the patients were hormone positive.43 (86%) underwent Breast Conservation Surgery (BCS) and 7(14%) underwent Mastectomy with axillary surgery .11(25.5%) patients among the BCS group received Tumour Bed Boost(10Gy in 5 fractions). All the patients received a dose of 26 Gy in 5 fractions with or without boost dose according to the protocol using 3D conformal therapy field in field technique. The patients were followed up for tumour control and normal tissue toxicity. RESULTS : All the 50 patients (100%) developed Grade I skin reactions and 8 (16%) patients had mild breast discomfort. No major acute toxicities were encountered during the treatment and follow-up. The breast cosmesis was well maintained and there was no evidence of disease recurrence during the follow-up period. All the patients are being constantly followed up for late toxicities. CONCLUSION: Ultrahypofractionated radiotherapy for early breast cancer is a feasible modality in our Indian scenario. Acute toxicities were not seen except mild erythema, we need to follow-up the patients for any late toxicities before making this protocol as the standard of care in our setting. Keywords: Ultrahypofractionated radiotherapy, FAST FORWARD, Early breast cancer, Breast conservation surgery, mastectomy, Tumour bed boost