De-escalated Weekly Dose of Palliative Breast Radiotherapy
Posted: Friday, December 4, 2020
Chemotherapy and surgery are often ineffective in relieving discomfort and enhancing quality of life for patients with advanced and metastatic breast cancer who have large, fungating tumors. Previously, Arun T. Sr, MD, of All India Institute of Medical Sciences, New Delhi, and colleagues demonstrated that high-dose hypofractionated radiotherapy in five fractions at 8 Gy weekly was effective but still caused toxicity. At the virtual edition of the 2020 American Society for Radiation Oncology (ASTRO) Annual Meeting (Abstract 23), they showed that a de-escalated total dose of 24 Gy (8 Gy weekly in three fractions) decreased toxicity without compromising outcomes.
A total of 37 patients were eligible for the trial. Participants were treated with two tangential photon fields, to avoid the heart and lungs. Of the 37 patients, 13 received the 24 Gy in three fractions over 3 weeks, and 24 of them were treated over 5 weeks with 40 Gy in five fractions. Of all the participants, 28 had metastatic disease, and 9 were unable to undergo surgery.
A total of 17 patients had skin lesions, including Peau d’orange (n = 10), ulceration (n = 8), and satellite lesions (n = 6). Chest-wall tumors affected seven patients. Grade 2, grade 3, and grade 4 dermatitis affected 41.6%, 8.3%, and 4.2% patients in the 40-Gy arm, respectively; in the 24-Gy group, 30.8% of patients had grade 2 dermatitis. A total of 20.8% and 4.2% of participants in the 40-Gy group had fair and poor prognoses, respectively, whereas there were no cases of fair or poor cosmesis in the 24-Gy group (P = .059). In the 40-Gy cohort, 16.7% of patients experienced disease progression, whereas in the 24-Gy cohort, 15.4% did. Additionally, a total of 13 patients died of their disease during this trial.
Disclosure: For full disclosures of the study authors, visit redjournal.com.
