Short Effect And Adverse Reaction Observation On Hypofractionated Radiotherapy For Early Stage Breast Cancer After Breast-conserving Surgery

Objective:To investigate the difference between short-term efficacy and adverse effects of hypofractionated radiotherapy and conventional fractionated radiotherapy on patients with early breast cancer after breast-conserving surgery.The results will provide research basis for choosing the best adjuvant radiotherapy for patients with breast cancer after breast-conserving surgery.Methods: From December 01,2016 to June 30,2019,in the First Affiliated Hospital of Bengbu Medical College,46 patients with p Tis-3N0-1M0 breast cancer after breast-conserving surgery were treated in the Radiotherapy department,aged 26-67 years.They were given divided Intensity-modulated radiotherapy,the whole breast irradiation dose of 42.56 Gy in 16 fractions,the electronic line supplement of the tumor bed boost of 10.64 Gy in 4 fractions,and the total treatment period is 26 d.In the same period,matched and compared with patients treated by conventional fractionated radiotherapy after breast-conserving surgery,aged 32-71 years old.Conventional fractionated was given 50Gy/25 F dose of total breast irradiation,the tumor bed boost electron beam supplement was 10Gy/5F,the total course of treatment is 40 d.Among the patients in the hypofractionated group,38 received adjuvant chemotherapy,31 in endocrine therapy,and 5 in HER-2 targeted therapy.There was no significant difference compared with the general clinical data of the conventional fractionated group.Follow-up was performed to evaluate whether there were any differences in the short effect,adverse reactions,and cosmetic effects between the two groups of patients.Results: The median follow-up time of the hypofractionated and the conventional fractionated group was 17 months(range 5-34 months)and 17.5 months(range 5-35 months).The survival rate of both groups during the follow-up period was100%,and no distant metastasis was seen.Local regional control: hypofractionated group: 1 case had ipsilateral breast and axillary recurrence 6 months after radiotherapy;conventional fractionated group: no recurrence occurred during the follow-up period.Short-term radiation dermatitis: hypofractionated group:40 cases of grade 1(87.0%),5 cases of grade 2(10.9%);conventional fractionated group:39 cases of grade1(84.8%),4 cases of grade 2(8.7%),none see Grade 3and above radiation dermatitis.There was no statistical significance in the incidence of radiation dermatitis in the two groups of patients(P = 0.375).Bone marrow suppression: hypofractionated group:16 cases of grade1 leukopenia(34.8%),3 cases of grade2(6.5%),1 case of grade 3(2.2%);2 cases of grade1 platelet decline(4.3%);hemoglobin reduction in 1 case(2.2%)of grade1,2 cases(4.3%)of grade 3;conventional fractionated group: leukopenia of 13 cases of grade 1(28.3%),9 cases of grade 2(19.6%),2 cases of grade 3(4.3%);2 cases of grade 1 platelet decline(4.3%),1 case of grade 2(2.2%);7 cases of grade1 hemoglobin reduction(15.2%),and bone marrow suppression in the two groups had no statistical significance.No radiation esophageal mucosal reaction or radiation pneumonia occurred during the follow-up period in both groups.Lymphedema: hypofractionated group: mild 2cases(4.3%);conventional fractionated group: mild 1 case(2.2%).Cosmetic effects: hypofractionated group: good or excellent cosmetic outcome 39 cases(84.8%),6 cases(13.0%)in general;conventional fractionated group: good or excellent cosmetic outcome 41cases(89.1%),4 cases(8.7%)in general.Compared with the conventional fractionated radiotherapy method,the number of fractionated radiotherapy was reduced by 10 times,and the total treatment period was shortened from 40 days to 26 days.The difference in the cost of radiation therapy was about 13,000 yuan.Conclusion: Hypofractionated radiotherapy has similar local tumor control and cosmetic effects as conventional fractionated radiotherapy,with no increase in adverse reactions.It also has significant advantages in shortening treatment time,reducing treatment costs,saving medical resources,and improving patient compliance.Its long-term efficacy remains to be seen further clinical observation.