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William J. Gradishar, MD, FACP, FASCO


ASTRO 2023: Quality of Life and Radiation Fractionation Choices After Mastectomy

By: Celeste L. Dixon
Posted: Monday, October 9, 2023

Early results of the randomized FABREC trial, presented at the 2023 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract LBA 05), seem to support the use of hypofractionated photon postmastectomy radiation therapy in the setting of tissue expander– or implant-based breast reconstruction as an alternative to conventionally fractionated photon postmastectomy radiation therapy. This first-of-its-kind study compared quality-of-life and clinical outcomes in this patient population.

“Both the accelerated and standard courses of treatment were equally effective at preventing the cancer from returning and had the same level of side effects. But with shortening the treatment from 5 weeks to 3, patients experienced fewer treatment disruptions, a lower financial burden, and other meaningful improvements to their lives,” said senior study author Rinaa Punglia, MD, MPH, FASTRO, of Dana-Farber Brigham Cancer Center, Boston, in an ASTRO press release.

At 6 months, the overall changes in Physical Well-Being score outcomes were comparable between hypofractionated (16 fractions; 42.56 Gy across about 3 weeks) and conventionally fractionated postmastectomy radiation therapy (25 fractions; 50 Gy across 5 weeks). There were no significant differences between the two treatment arms (P = .71), and the treatments’ overall toxicity profiles were similar.

However, significant differences emerged in other domains for the shorter versus longer treatment courses: Patients younger than age 45 years receiving hypofractionated postmastectomy radiation therapy versus those receiving conventional postmastectomy radiation therapy appeared to be less bothered by adverse effects of treatment (P = .045) and nausea (P = .02). Further, among the 51 patients who took unpaid time off from work during treatment, those who received the shortened treatment regimen required fewer hours off than those receiving the conventional treatment regimen (P = .046).

Median follow-up was 40.4 months. Preoperative chemotherapy was used in 67.8% and preoperative endocrine therapy, in 21.5% of the women, and all had their tissue expander or implant placed immediately after mastectomy.

Disclosure: Dr. Punglia reported no conflicts of interest.

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