Hypofractionated radiotherapy (RT) is becoming a new standard in the adjuvant treatment for patients with breast cancer. However, data are lacking on late-term arm and shoulder morbidity with hypofractionation in patients with advanced stage disease who undergo mastectomy followed by local and regional nodal irradiation (RNI). In this study, we report late-term effects in arm and shoulder with 3 weeks of RNI with hypofractionation in patients with breast cancer.
Between January 1990 and December 2007, 1770 women with stage II and III breast cancer post mastectomy, prospectively treated with hypofractionated local and RNI were analyzed for late-term effects on arm and shoulder. RT dose was 35Gy/15#/3 wks to chest wall by two tangential fields and 40Gy in same fractions by a single incident field to supraclavicular fossa. Late-term toxicities were assessed with RTOG LENT SOMA scale. All late effects assessment scores were dichotomised as none/mild versus moderate/marked effects.
Median follow up was 10 years. Chemotherapy and hormonal therapy was given to 1136(63%) and 1381(74%) of patients, respectively. RNI was delivered in 1689(95%) of patients. Moderate/severe arm/shoulder pain was reported by 374(22%) patients. Moderate/severe difficulty in abducting arm was reported by 269(16%) patients. Moderate/marked arm edema was seen in 131(7.7%) of patients. Brachial plexopathy was not seen in any of the patients.
Hypofractionated local and RNI in 3 weeks was associated with modest arm and shoulder late-term effects. Table. Patients characteristics Characteristics Total=1770 n(%) Age ≤40 491 (28) >40 1279 (72) Menopausal Status Pre-menopausal 828 (47) Post-menopausal 942 (53) Tumor stage T1 906 (51) T2 659 (37) T3 34 (2) T4 171 (10) Histology Invasive Ductal Carcinoma (IDC) 1628 (92) Non-IDC 142 (8) Grade 1 2318 (18) 2 1134 (64) 3 318 (18) N Stage (pathological) N0 654 (37) N1 593 (34) N2 383 (22) N3 140 (8) Surgical Margins Negative 1562 (88) Positive 208 (12) Estrogen Receptor Status Positive 859 (62) Negative 530 (38) Unknown 381 Progesterone Receptor Status Positive 729 (53) Negative 632 (47) Unknown 409 Chemotherapy Yes 1136 (64) No 634 (36) Hormonal Therapy Yes 1381 (78) No 389 (22).
PGIMER, Chandigarh.
Has not received any funding.
All authors have declared no conflicts of interest.