B E doubleD.
The Study: Despite 10-year follow-up from 4 randomized trials supporting its use, the uptake has been slow. The slow and steady wins the race camp primarily cite cosmetic concerns surrounding a lack of data with boosts, chemo, or larger breasts. So this phase 3 non-inferiority trial was designed specifically for all the tortoises out there. It randomized 247 women with stage I-II breast cancer to receive conventional (50 Gy / 25) versus hypofractionated (42.56 / 16) adjuvant whole breast radiation. Importantly all were followed by tumor bed boosts mostly of 10 Gy / 5 and 10 Gy / 4, respectively. Also pertinent is that almost one-third received chemo and over one-third had ≥ D-cup breasts. The primary endpoint was “adverse” patient-reported cosmesis at 3 years, defined as ≥ 2.5 on a scale from 1 to 4 (1 = no and 4 = large difference) when comparing the treated to the untreated breast. Tortoises better dust off their running shoes: the rate of adverse cosmesis was almost double with the conventional (14%) versus hypofractionated (8%) regimen. Who did best with an accelerated course? Those with at least D-cups, who enjoyed an 18% absolute advantage in rate of adverse cosmesis with hypofractionation. Beyond the obvious, this trial suggests that estimations of clinical outcomes based on breast BED are BAD.
Bottom Line: Hypofractionated whole breast radiation is a faster, effective way to prevent breast cancer recurrences AND it has women feeling good when they look in the mirror. | Shaitelman, J Clin Oncol 2018 & Recht, Int J Radiat Oncol Biol Phys 2018