LATE COSMETIC RESULTS OF SHORT FRACTIONATION FOR BREAST-CONSERVATION

Backgroud and purpose: The number of fractions of radiation therapy (R T) used after breast conserving surgery varies widely and accounts for a significant proportion of the workload in a modem radiotherapy depa rtment. internationally, 'standard' therapy ranges from 3 to 7 weeks o f daily treatment with or without a boost. Short RT schedules have the attraction of reducing workload but raise concern about an increased risk of late effects and poorer cosmetic outcome. Materials and method s: In a randomized trial, 186 women with T1 or T2, pathologically node -negative breast cancer had cosmetic and Various normal tissue effects data collected prospectively. The breast RT prescription was 44 Gy in 16 daily fractions to a tangent pair. Results: Median follow-up is 6. 7 years. Actuarial 5-year breast recurrence was 6%. Overall cosmetic r esults at 5 years were good or excellent in 89% and 96% as reported by physicians and patients, respectively, and were stable between 2 and 5 years. Breast discomfort, erythema, edema and induration were relate d to both surgery and RT. At 5 years, 20% had breast discomfort, 18% h ad induration, 6% had erythema and 3% had some degree of breast edema. Fewer patients had these effects at 5 years than immediately after pr imary surgery. The presence of induration prior to starting RT was ass ociated with a greater likelihood of breast induration 3 or more years following RT (P=0.02). Thirteen percent of patients, generally those with large breasts, developed mild inframammary telangiectasia by 5 ye ars. Conclusions: Results are comparable to those reported from center s employing more conventional fractionation. Short fractionation produ ces acceptable cosmetic results for the majority of women if there are no contraindications to RT and in the absence of significant post-ope rative breast induration.