At five years following accelerated treatment, the rate of locoregional recurrence, where disease returns in the breast or region near the breast, was noninferior to the rate for standard treatment. Locoregional recurrence rates were 8.3 percent following accelerated treatment and 8.1 percent following standard treatment (Hazard Ratio (HR) = 1.10, 95% CI 0.67-1.83), with a difference of 0.2 percent (95% CI = -4.1 to 4.5).
Among all patients, the five-year overall survival rate was 84.4 percent, and the disease-free survival rate was 72.7 percent. Five-year overall survival rates were 83.2 percent following accelerated treatment and 85.6 percent following standard treatment (HR = 1.13, 95% CI 0.78-1.62). Five-year disease-free survival rates were 74.6 percent for the accelerated treatment arm and 70.7 percent following standard treatment (HR = 0.88, 95% CI 0.67-1.16).
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Rates of distant metastases, where a patient develops tumors outside the region of the original tumor, were 23.2 percent and 26.2 percent at five years for accelerated and standard treatment, respectively (HR = 0.90, 95% CI 0.67-1.20). Survival and recurrence rates were calculated using the Kaplan-Meier method and analyzed using Cox regression models.
The two cohorts did show some differences in terms of treatment-related side effects. Fewer patients in the accelerated treatment group experienced grade 3 acute skin toxicity (3.5% versus 7.8% of standard-treatment patients; p = 0.008). Rates between the treatment arms were similar for symptomatic radiation pneumonitis, lymphedema and shoulder disorder, and no patients experienced brachial plexopathy. Toxicity rates were compared using Chi-square tests.
“Clinicians have seen clear benefits with accelerated radiation therapy to the whole breast after breast-conserving surgery but questions remain about its safety and effectiveness with treating nodal regions. Our trial demonstrates a similar benefit for intermediate-stage breast cancer after mastectomy, in that we reduced treatment time from five weeks to three weeks while preserving high rates of tumor control and tolerability,” said Dr. Wang.
“The accelerated approach also has practical value for patients. With fewer treatment sessions, patients spend less time away from work and family, enjoy lower transportation costs and, as our findings show, experience fewer side effects.”
The abstract, “Hypofractionated radiotherapy after mastectomy for the treatment of high-risk breast cancer: 5-year follow up result of a randomized trial,” will be presented in detail during a news briefing and the plenary session at ASTRO’s 59th Annual Meeting in San Diego (full details below).
