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Study: Hypofractionated Radiation Regimen is Equivalent to Conventional Radiation Course in Women with Post-Mastectomy Breast Reconstruction

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In reportedly the first randomized study to compare hypofractionated radiation treatment versus conventional radiation treatment for women who had breast reconstruction procedures after mastectomy, researchers at the recent ASTRO conference noted similar rates of cancer recurrence, chest wall toxicity and patient well-being.

Could a hypofractionated radiation regimen be a viable option for women who have had post-mastectomy breast reconstruction?

In a recent multicenter randomized study, researchers compared conventional radiation (CF) treatment (25 fractions of 50 Gy administered over a five-week period) to a hypofractionated radiation (HF) regimen (16 fractions of 42.56 Gy administered over a three-week period) in 400 women (median age of 47) who had post-mastectomy breast reconstruction procedures. The researchers pointed out that 67.8 percent of the cohort received preoperative chemotherapy and 21.5 percent of study participants had preoperative endocrine therapy.

Presenting their findings at the recent American Society for Radiation Oncology (ASTRO) conference, the study authors found that both treatment arms had the same number of local-regional cancer recurrence (one case) and distant recurrence (eight cases). While there was a slightly higher incidence of chest wall toxicity in the HF cohort (19 cases) versus the CF group (16), the researchers noted that multivariate analysis showed no significant correlation between the HF regimen and chest wall toxicity.

For self-reported physical well-being, the researchers noted no significant difference between the HF and CF cohorts at six months. For the HF cohort, there were significant differences in the incidence and length of treatment breaks. Patient who had the HF radiation regimen had a 2.7 percent incidence of treatment breaks with a 2.8-day average for those breaks in comparison to a 7.7 percent incidence and a 3.3-day average for treatment breaks in the CF cohort, according to the study authors.

The researchers also found that patients in the HF cohort had over 50 fewer hours of unpaid time off from work during treatment (73.7 hours) in comparison to the CF group (125.8 hours).

“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 five weeks to three, patients experienced fewer treatment disruptions, a lower financial burden, and other meaningful improvements to their lives,” noted senior study author Rinaa Punglia, M.D., MPH, FASTRO, an associate professor of radiation oncology at Dana-Farber Brigham Cancer Center in Boston.

Reference

1. Wong JS, Uno H, Tramontano A, et al. Patient-reported and toxicity results from the FABREC study: a multicenter randomized trial of hypofractionated vs. conventionally fractionated postmastectomy radiation therapy after implant-based reconstruction. Abstract presented at the American Society for Radiation Oncology (ASTRO) 2023 Annual Meeting, October 1-4, San Diego. Available at: https://www.astro.org/Meetings-and-Education/Micro-Sites/2023/Annual-Meeting

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