Outcome of short course hypofractionated radiation therapy with boost in early breast cancer: Local Control and Cosmesis

Background: Hypo-fractioned whole breast irradiation with a subsequent boost 
is equivalent to conventional whole-breast irradiation and is well-tolerated in 
terms of local recurrence, toxicity and cosmetic outcome. The aim of the present 
study is to assess effect of HF-WBI followed by sequential boost over a total of 
15 treatment days regarding to locoregional control and cosmesis in patients 
with early breast cancer.
Patient and Methods: Sixty early stage breast cancer patients were randomly 
allocated into 2 Arms (thirty patients in each arm), Arm A (standard 
hypofractionation arm, whole breast irradiation HF-WBI 40Gy/15fractions 
followed by boost 10Gy/5 fractions) and Arm B (short hypofractionated arm, 
HF-WBI 36.63Gy/11 followed by boost of 13.32Gy/4 fractions), with an 
equivalent dose to the regional nodes if indicated in both arms. 
Results: There was encouraging locoregional control results in both arms. 
Ninety percent of patients in arm A and 76.67% of patients in arm B at our 
study had a good to excellent cosmetic outcome while 10% in arm A and
23.33% of patients in arm B had fair cosmetic outcome after finishing 
radiotherapy. There is improvement in cosmesis as after 12 months of follow 
up, there are 100% in arm A and 93.33% of patients in arm B good to excellent 
cosmesis.
Conclusion: A significant difference between the 2 protocols regarding 
cosmesis was noted as Arm A had better cosmetic outcome on follow up. 
However, both arms had encouraging local control results in follow-up after 
12and 18 months. Thus, a shortened 3-week HF-WBI schedule is as safe, 
effective with excellent local control and non inferior cosmetic results as 
standard 4-weeks HF-WBI and may be a reasonable alternative following breast 
conservation surgery with time and cost benefit.