HYPOFRACTIONATEDRADIOTHERAPY OF BREAST CANCER IN ELDERLYWOMEN

Introduction: Breast cancer remains the first malignantpathology in women and itsdiagnosis in elderlywomenislate. The aim of ourworkis to evaluate the effectiveness of hypofractionatedradiotherapy in the treatment of breast cancer in elderlywomen. Material And Methods: This is a retrospectivestudy of 171 patients aged over 65 yearsfollowed for invasive breast cancer and whoreceived adjuvant hypofractionatedradiotherapy at the radiotherapydepartment of CHU Hassan II Fez fromJanuary

Introduction:Breast cancer remains the first malignantpathology in women and itsdiagnosis in elderlywomenislate. The aim of ourworkis to evaluate the effectiveness of hypofractionatedradiotherapy in the treatment of breast cancer in elderlywomen. Material And Methods: This is a retrospectivestudy of 171 patients aged over 65 yearsfollowed for invasive breast cancer and whoreceived adjuvant hypofractionatedradiotherapy at the radiotherapydepartment of CHU Hassan II Fez fromJanuary 2012 to December 2016. Results: The frequency of breast cancer in womenaged over 65 yearswas 7.31%. The averageage of our patients was 70 years (65-88 years) of which 40% wereolderthan 70 years. 8.5% of patients had a familyhistory of breast cancer. The delay of consultation was 10 months. A breast nodule was the revealingsign in all patients withinflammatorysigns in 4.6%;axillaryadenopathywasfound in 20% of patients. All cancers werehistologicallyproven. The cancer wasinfiltratingductal in 90% of cases. 27% of the tumorswereScarff-Bloom and Richardson grade I, 45% grade II, 30% grade III. Hormone receptorswereexpressed in 77% and HER positive in 10% of patients. 83% underwentmastectomywithlymphnode dissection followed by adjuvant radiotherapyaccording to the hypo-fractionatedprotocol: total dose of 42Gy on the wall, of which 32% of patients alsoreceivedlymphnode irradiation, fractionation 2.8Gy/Fr in 15 sessions, spread over 19 days 17% of the patients had conservative surgeryassociatedwith adjuvant externalradiotherapy on the breastaccording to the sameschemewith a boost of 11.8Gy on the tumorbed, spread over 25 days.After a medianfollow-up of 5 years, overallsurvivalwasestimated at 84.2%, locoregionalrecurrence-free survival at 84.7% and metastaticrecurrence-free survival at 83%. Acute toxicityconsisted of radiodermatitis in 81% of patients, and postradiation fibrosis in 15%, and no long-termcardiac or pulmonarytoxicitywasobserved. Conclusion: For elderly patients, adjuvant hypofractionated irradiation seems to be a good alternative, with a good rate of local control, and withoutincreasedtoxicity.
For severaldecades, adjuvant radiation therapy programs for these patients have delivered 25 fractions of 2 Gy over 5 weeks. Randomizedcontrolled trials with long-termfollow-up have sinceconfirmedthatfewer and larger fractions, giving a lower total dose, are at least as safe and effective as the previouslyused international standard (1).

Material and Methods:
This is a retrospectivestudy, involving 171 patients aged over 65 yearsfollowed for invasive breast cancer and whoreceivedhypofractionated adjuvant radiotherapy at the radiotherapydepartment of CHU Hassan II Fez fromJanuary 2012 to December 2016.
Patients receivedthree-dimensional adjuvant radiotherapyaccording to the hypo-fractionatedprotocol: total dose of 42Gy on the wall of which 32% of patients alsoreceivedlymphnode irradiation, fractionation 2.8Gy/ Fr in 15 sessions.
Statistical analyses wereperformedwith SPSS version 20 software. The analyses of OS, SSRL PFS and DFS wasestimated by the Kaplan-Meier method, and the coxmethodwasused for multifactorialanalysis.

Discussion:-
Our objective was to determinewhetherwhole-breast irradiation after conservative surgery or mastectomycouldbesafe and effective whendelivered at a higher dose per fraction and over a shorterperiod of time in elderlywomenthan in the standard regimen.
Standard treatmentdelivering 50 Gy in 25 fractions to the breast or wall and or not to the lymphnodes and or not to the tumorbedwith 10 to 16 Gy of additional radiation in conventionalfractionationisrelatively long and restrictive, especially for elderly patients and/or patients with long tracts (2). In 2000, in a study in the United States, Athas et al. showed that up to 33% of womentreatedwith conservative surgerydid not receive the adjuvant radiotherapytheyshould have had, mainlybecause of age over 70 years and distance to the radiotherapy center [3].

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Variousaccelerated and non-acceleratedhypofractionated irradiation regimens have been tested to addressthis issue. Data from four large phase III non-inferiority trials, showed, withlevel of evidence IA, thathypofractionatedbreastradiotherapywas non-inferior to normofractionatedradiotherapy, both in terms of efficacy and toxicity [4][5][6].
The randomized phase III Fast-Forward trial showed non-inferiority of the 27Gy and 26Gy 5-fraction regimenscomparedwith 40Gy 15-fraction regimen, with the incidence of local relapse at 5 yearsafterhypofractionatedradiotherapygiven in five fractions being no lowerthan the standard 3-week regimen. The 26 Gy dose levelissimilar to the 40 Gy 15-fraction dose level in terms of patient-rated normal tissue effects, clinician-rated normal tissue effects, and breastappearance change. The consistency of the FAST-Forwardresultswithprevioushypofractionation trials supports the adoption of 26 Gy in five daily fractions as the new standard for womenwithoperablebreast cancer requiring adjuvant radiation therapy (1).

Conclusion:-
In thisseriesevaluating a hypofractionatedregimen in elderly patients with invasive breastcarcinoma, the results are promisingboth in terms of locoregional control and toxicity. This hypofractionatedregimenallows to decongest the treatment machines and to shorten the waiting time for our patients.