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Long-Term Results of Postoperative Hypofractionated Accelerated Breast and Lymph Node Radiotherapy (HypoAR) with Hypofractionated Boost

1
1st Department of Radiology, Radiotherapy Unit, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
2
Department of Radiotherapy/Oncology, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
3
Department of Pathology, Democritus University of Thrace, University Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(5), 3474-3487; https://doi.org/10.3390/curroncol28050300
Received: 9 July 2021 / Revised: 22 August 2021 / Accepted: 4 September 2021 / Published: 7 September 2021
(This article belongs to the Section Gynecologic Oncology)
We report long-term results (median follow-up 12 years) of hypofractionated accelerated radiotherapy (HypoAR) in patients treated with breast-conserving surgery. In total, 367 women were treated with HypoAR. Axillary and supraclavicular area (ASA) were treated in patients with involved nodes. In total, 290 patients (scheme A) received 3.5 Gy/day ×10 fractions (breast/ASA) followed by two 4 Gy fractions with electrons to the affected breast quadrant within 16 days. In total, 77 patients (Scheme B) received 2.7 Gy/day for 16 consecutive fractions (breast/ASA) within 22 days, while concurrently, the affected breast quadrant received an electron booster dose of 0.8 Gy for the first 13 fractions. Amifostine was offered to 252/367 patients. Early radiation toxicity was minimal. Regarding late toxicities, symptomatic breast edema was noted in 2.2%, asymptomatic breast fibrosis in 1.9%, and arm lymphedema in 3.7% of patients. Amifostine reduced early radiation dermatitis (p = 0.001). In total, 2.2% of patients developed contralateral breast and 1.6% other carcinomas. Locoregional recurrence (LR) occurred in 3.1% of patients (0% for in situ carcinomas). Positive margins after surgery, extracapsular node invasion, and HER2-enriched/triple-negative tumors were linked with significantly worse LR-free survival. The involvement of more than three nodes and luminal type other than A were independent prognostic variables of metastasis and death events. HypoAR delivering a biological dose of 50–52 Gy to the breast/ASA is a safe and effective therapy for patients treated with conservative surgery. The risk of carcinogenesis is low. Positive surgical margins, extracapsular node invasion, and HER2-enriched/triple-negative phenotypes appear as a cluster of features linked with a higher risk for locoregional relapse. View Full-Text
Keywords: breast cancer; conservative surgery; radiotherapy; hypofractionation; acceleration breast cancer; conservative surgery; radiotherapy; hypofractionation; acceleration
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MDPI and ACS Style

Koukourakis, I.M.; Panteliadou, M.; Giakzidis, A.G.; Nanos, C.; Abatzoglou, I.; Giatromanolaki, A.; Koukourakis, M.I. Long-Term Results of Postoperative Hypofractionated Accelerated Breast and Lymph Node Radiotherapy (HypoAR) with Hypofractionated Boost. Curr. Oncol. 2021, 28, 3474-3487. https://doi.org/10.3390/curroncol28050300

AMA Style

Koukourakis IM, Panteliadou M, Giakzidis AG, Nanos C, Abatzoglou I, Giatromanolaki A, Koukourakis MI. Long-Term Results of Postoperative Hypofractionated Accelerated Breast and Lymph Node Radiotherapy (HypoAR) with Hypofractionated Boost. Current Oncology. 2021; 28(5):3474-3487. https://doi.org/10.3390/curroncol28050300

Chicago/Turabian Style

Koukourakis, Ioannis M., Marianthi Panteliadou, Axiotis G. Giakzidis, Christos Nanos, Ioannis Abatzoglou, Alexandra Giatromanolaki, and Michael I. Koukourakis 2021. "Long-Term Results of Postoperative Hypofractionated Accelerated Breast and Lymph Node Radiotherapy (HypoAR) with Hypofractionated Boost" Current Oncology 28, no. 5: 3474-3487. https://doi.org/10.3390/curroncol28050300

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