Shaitelman
et al on a paper published by JAMA Oncol
report the 6-month toxic effects and quality
of life (QOL) with conventionally fractionated (CF-WBI) whole-breast
irradiation (WBI) vs. hypo-fractionated WBI (HF-WBI).
Their study included 287 women 40
years or older with stage 0 to II breast cancer for whom WBI without addition
of a third field was recommended. It was
conducted between February 2011 through February 2014 and the patients were observed
for a minimum of 6 months.
The study was un-blinded randomized
trial of CF-WBI (n = 149; 50.00 Gy/25 fractions + boost [10.00-14.00 Gy/5-7 fractions]) vs HF-WBI (n = 138; 42.56 Gy/16 fractions + boost
[10.00-12.50 Gy/4-5 fractions]) following breast-conserving surgery.
Of 287 participants, 149 were
randomized to CF-WBI and 138 to HF-WBI. Treatment arms were well matched for
baseline characteristics, including FACT-B total score (HF-WBI, 120.1 vs
CF-WBI, 118.8; P = .46) and individual QOL items such
as somewhat or more lack of energy (HF-WBI, 38% vs CF-WBI, 39%; P = .86) and somewhat or more trouble meeting family needs (HF-WBI,
10% vs CF-WBI, 14%; P = .54). Maximum
physician-reported acute dermatitis (36% vs 69%; P < .001), pruritus (54% vs 81%; P < .001), breast pain (55% vs 74%; P = .001), hyperpigmentation (9% vs 20%; P = .002), and fatigue (9% vs 17%; P = .02) during irradiation were lower in patients randomized to
HF-WBI. The rate of overall grade 2 or higher acute toxic effects was less with
HF-WBI than with CF-WBI (47% vs 78%; P < .001). Six
months after irradiation, physicians reported less fatigue in patients
randomized to HF-WBI (0% vs 6%; P = .01), and
patients randomized to HF-WBI reported less lack of energy (23% vs 39%; P < .001) and less trouble meeting family needs (3% vs 9%; P = .01). Multivariable regression confirmed the superiority of
HF-WBI in terms of patient-reported lack of energy and trouble meeting family needs.
The authors concluded that treatment with
HF-WBI appears to yield lower rates of acute toxic effects than CF-WBI as well
as less fatigue 6 months after completing radiation therapy.
JAMA Oncol. Published online August 06,
2015.
