Adjuvant hypofractionated versus conventional fractionated radiotherapy in nodal positive breast cancer

Background: For patients with breast cancer, radiation therapy (RT) is an effective treatment option. Locoregional RT is linked to significant decreases in local and regional recurrence, as well as modest gains in distant disease control and survival. Data analysis of multiple previous studies confirmed that hypofractionated (HF) breast RT has the same effect of conventional fractionation as regards controlling of the disease in node negative breast cancer. Concerns regarding side effects and a lack of data on the efficacy of hypofrationation for node-positive cases have limited the use of HF regional nodal RT
Patients and methods: This is a retrospective study assessed long-term, breast cancer-specific outcomes in node positive cases. 618 patients were included. And according to the radiotherapy protocol of treatment they divided into 2 groups; group 1 included 316 cases received conventional fractionation radiotherapy (50gy/25 ttt/5 weeks) and group 2 included 302 cases received hypofractionation radiotherapy (40gy/15 ttt/3 weeks). The 2 groups were compared regarding; time to develop local recurrence or distant metastasis, survival and toxicity.
Results: both groups were matched as regards clinicopathological fissures. The median follow up period was 113 months (ranged between 96 and 130 months). At the end of the study, 53 patient developed local recurrences (26 in group 1 and 27 in group 2) while 105 patients developed distant metastasis (54 in group1 and 51 in group2). 93 cases were died because of the disease (47 in group 1 and 46 in group 2). The results were matched between the 2 groups. Recurrence free survival for group 1 was 125.823 months compared to 125.922 for group 2. Distant metastasis free survival for group 1 was 124.063 while was 124.281 for group 2. The overall survival was 127.316 for group 1 compared to 126.967 for group 2. For all survival data there was no significant P value between the 2 groups. When considering sub-groups with higher risk for failure (G3, N2 or 3 and triple negative cases), also there was no significant P-value as regards survival data between both groups. Toxicity was so limited and comparable between both groups.
Conclusion: using hypofractionation was effective as conventional fractionation for patients with node-positive breast cancer. This model of therapy will be very helpful in developing countries with limited resources. However still more large studies are needed to confirm our results.