FAST from the past.
Can post-mastectomy radiation (PMRT) be delivered in just 6 fractions? In this retrospective study, over 450 women with stage I-III breast cancer were treated with ultra-hypofractionated post-mastectomy radiation at a single center in Paris between 2000 and 2009. What happened after 2009? The center moved to moderately hypofractionated PMRT after publication of the START trials. PMRT consisted of 26 Gy in 6 fractions with 4 fractions of 4 Gy on days 1, 3, 15, and 17, and then 2 fractions of 5 Gy on days 29 and 31. A supraclavicular field was used for patients with lymph node involvement, but internal mammary coverage was not routine. With a median follow-up of just over 10 years, the cumulative rate of local recurrence was 9.2%, regional recurrence was 10.5%, and locoregional recurrence was 15.1%. These recurrence rates were higher than those seen in many other studies of moderately hypofractionated PMRT. In addition, IMN failures occurred in 22.4% of those with regional failure. The rate of 3+ cardiopulmonary toxicity was 3.3% and the rate of severe lymphedema was 4.4%. | Mignot, Int J Radiat Oncol Biol Phys 2021