Significance of Hypofractionated Radiotherapy in Postoperative Irradiation for Breast Cancer: An Asian Multi-institutional Prospective Study

Okonogi N. Kono S. Karasawa K. Banu P.A. Xu X. Erawati D. Adylkhanov T. Jang W.I. E. Y. Calaguas M.J. Thephamongkhol K. Dung T.A. Ng W.N.P. Kato S.
July 2023 Elsevier Ltd

Clinical Oncology
2023 #35 Issue 7 463 - 471 pp.

Aims: There is a need for the adequate distribution of healthcare resources in Southeast Asia. Many countries in the region have more patients with advanced breast cancer who are eligible for postmastectomy radiotherapy (PMRT). Therefore, it is critical that hypofractionated PMRT is effective in most of these patients. This study investigated the significance of postoperative hypofractionated radiotherapy in patients with breast cancer, including advanced breast cancer, in these countries. Materials and methods: Eighteen facilities in 10 Asian countries participated in this prospective, interventional, single-arm study. The study included two independent regimens: hypofractionated whole-breast irradiation (WBI) for patients who had undergone breast-conserving surgery and hypofractionated PMRT for patients who had undergone total mastectomy at a dose of 43.2 Gy in 16 fractions. In the hypofractionated WBI group, patients with high-grade factors received additional 8.1 Gy boost irradiation sessions for the tumour bed in three fractions. Results: Between February 2013 and October 2019, 227 and 222 patients were enrolled in the hypofractionated WBI and hypofractionated PMRT groups, respectively. The median follow-up periods in the hypofractionated WBI and hypofractionated PMRT groups were 61 and 60 months, respectively. The 5-year locoregional control rates were 98.9% (95% confidence interval 97.4–100.0) and 96.3% (95% confidence interval 93.2–99.4) in the hypofractionated WBI and hypofractionated PMRT groups, respectively. Regarding adverse events, grade 3 acute dermatitis was observed in 2.2% and 4.9% of patients in the hypofractionated WBI and hypofractionated PMRT groups, respectively. However, no other adverse events were observed. Conclusion: Although further follow-up is required, hypofractionated radiotherapy regimens for postoperative patients with breast cancer in East and Southeast Asian countries are effective and safe. In particular, the proven efficacy of hypofractionated PMRT indicates that more patients with advanced breast cancer can receive appropriate care in these countries. Hypofractionated WBI and hypofractionated PMRT are reasonable approaches that can contain cancer care costs in these countries. Long-term observation is required to validate our findings.

Adjuvant radiotherapy , breast neoplasm , breast-conserving surgery , clinical trial , hypofractionation , mastectomy

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QST Hospital, National Institutes for Quantum Science and Technology, Inage-ku, Chiba City, Chiba, Japan
Department of Radiation Oncology, Tokyo Womens Medical University School of Medicine, Shinjuku-ku, Tokyo, Japan
Department of Radiation Oncology, Delta Hospital Limited, Dhaka, Bangladesh
The First Affiliated Hospital of Soochow University, Suzhou, China
Department of Radiotherapy, Dr. Soetomo Academic General Hospital, Surabaya, Indonesia
National Research Oncology Center, Astana, Kazakhstan
Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
Department of Radiation Oncology, National Cancer Center of Mongolia, Ulaanbaatar, Mongolia
Department of Radiation Oncology, St Lukes Medical Center, Quezon City, Philippines
Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of General Radiation Oncology, National Cancer Hospital, Hanoi, Viet Nam
Department of Radiotherapy & Oncology, National Cancer Institute, Putrajaya, Malaysia
Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama, Japan

QST Hospital
Department of Radiation Oncology
Department of Radiation Oncology
The First Affiliated Hospital of Soochow University
Department of Radiotherapy
National Research Oncology Center
Department of Radiation Oncology
Department of Radiation Oncology
Department of Radiation Oncology
Department of Radiology
Department of General Radiation Oncology
Department of Radiotherapy & Oncology
Department of Radiation Oncology

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