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Top Line: Between the Chinese trial reported last year and pandemic regimens, you’ve no doubt heard a lot of talk about hypofractionated post-mastectomy radiation (PMRT).
The Study: And while the big Western trial we’re all waiting for, RT CHARM, is pending, here we have a 5-year update from its phase 2 predecessor. In this trial, 69 women with IIA-IIIC breast cancer received 36.63 Gy in 11 fractions of PMRT to the chest wall and regional lymph nodes. Importantly, high risk features such as T4 disease and young age were allowed. The majority received chemotherapy (>90%), had axillary dissection (84%), underwent reconstruction (59%), and received a 13.32 Gy in 4 fraction scar boost (97%). Among reconstructions, 88% had temporary expanders during radiation. At 5 years, the rate of locoregional recurrence was 5% with a distant disease-free survival rate of 77% and overall survival of 90%. Late toxicity was fairly mild with 30% having grade 1 hyperpigmentation and 8% having late chest wall pain. Only one patient developed lymphedema. Finally, 35% had a grade 3 or 4 reconstruction complication.
TBL: Hypofractionated post-mastectomy radiation in a U.S. population appears to have favorable acute and late toxicity. | Poppe, Int J Radiat Oncol Biol Phys 2020