Comparing hypofractionated and conventionally fractionated whole breast irradiation for patients with ductal carcinoma in situ after breast conservation: a propensity score-matched analysis from a national multicenter cohort (COBCG-02 study).

Adult Aged Aged, 80 and over Breast Neoplasms / pathology Carcinoma, Ductal, Breast / radiotherapy Carcinoma, Intraductal, Noninfiltrating / pathology Female Follow-Up Studies Humans Mastectomy, Segmental Middle Aged Neoplasm Recurrence, Local / pathology Prognosis Radiation Dose Hypofractionation Radiotherapy, Adjuvant / mortality Retrospective Studies Survival Rate
Breast cancer Ductal carcinoma in situ Hypofractionated radiotherapy Multicenter study Propensity score matching

Journal

Journal of cancer research and clinical oncology
ISSN: 1432-1335
Titre abrégé: J Cancer Res Clin Oncol
Pays: Germany
ID NLM: 7902060

Informations de publication

Date de publication:
Jul 2021
Historique:
received: 03 11 2020
accepted: 22 11 2020
pubmed: 3 1 2021
medline: 8 6 2021
entrez: 2 1 2021
Statut: ppublish

Résumé

Randomized trials confirmed the efficacy and the safety of hypofractionated whole breast irradiation (HF-WBI) in patients with early-stage breast cancer. However, the role of HF-WBI in patients with DCIS after breast conserving surgery has not yet been clearly established in prospective randomized trials. The aim of this study was to evaluate if HF-WBI can be considered comparable to conventionally fractionated (CF)-WBI in DCIS patients. The analysis included DCIS patients from four Italian centers treated with CF-WBI 50 Gy/25 fractions or HFRT 40.5 Gy/15 fractions, without tumor bed boost. A propensity score matching (PSM) analysis was performed using a logistic regression that considered age, grading, presence of necrosis, resection margin status and adjuvant endocrine therapy. Five hundred twenty-seven patients was included (367 in the CF-WBI-group and 160 in the HR-WBI group). After 1:1 matching, 101 patients were allocated to the CF-WBI-group and 104 to the HF-WBI group. No correlation was observed between the type of RT schedule and LRFS (HR 1.68, 95% CI 0.82-3.45; p = 0.152). After PSM, no statistical difference was observed between the two RT group (HR 1.11, 95% CI 0.40-3.04; p = 0.833), with 3- and 5-years LRFS rates of 100% and 97.9% for CF-WBI and 95.6% and 94% for HF-WBI. A short course of radiation therapy seems to be comparable to CF-WBI in terms of clinical outcomes. These data support the use of hypofractionated schedules in DCIS patients, but considering the remaining uncertainties.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE
Randomized trials confirmed the efficacy and the safety of hypofractionated whole breast irradiation (HF-WBI) in patients with early-stage breast cancer. However, the role of HF-WBI in patients with DCIS after breast conserving surgery has not yet been clearly established in prospective randomized trials. The aim of this study was to evaluate if HF-WBI can be considered comparable to conventionally fractionated (CF)-WBI in DCIS patients.
MATERIALS AND METHODS METHODS
The analysis included DCIS patients from four Italian centers treated with CF-WBI 50 Gy/25 fractions or HFRT 40.5 Gy/15 fractions, without tumor bed boost. A propensity score matching (PSM) analysis was performed using a logistic regression that considered age, grading, presence of necrosis, resection margin status and adjuvant endocrine therapy.
RESULTS RESULTS
Five hundred twenty-seven patients was included (367 in the CF-WBI-group and 160 in the HR-WBI group). After 1:1 matching, 101 patients were allocated to the CF-WBI-group and 104 to the HF-WBI group. No correlation was observed between the type of RT schedule and LRFS (HR 1.68, 95% CI 0.82-3.45; p = 0.152). After PSM, no statistical difference was observed between the two RT group (HR 1.11, 95% CI 0.40-3.04; p = 0.833), with 3- and 5-years LRFS rates of 100% and 97.9% for CF-WBI and 95.6% and 94% for HF-WBI.
CONCLUSION CONCLUSIONS
A short course of radiation therapy seems to be comparable to CF-WBI in terms of clinical outcomes. These data support the use of hypofractionated schedules in DCIS patients, but considering the remaining uncertainties.

Identifiants

DOI: 10.1007/s00432-020-03483-5 PMID: 33387035
pubmed: 33387035
doi: 10.1007/s00432-020-03483-5
pii: 10.1007/s00432-020-03483-5
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

2069-2077

Références

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Auteurs

Fiorenza De Rose (F)

Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy.
Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy.

Maria Carmen De Santis (MC)

Radiotherapy Unit 1, Fondazione I.R.C.C.S Istituto Nazionale Tumori di Milano, Milano, Italy.
Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy.

Bruno Meduri (B)

Radiation Oncology Unit, University Hospital of Modena, Via del pozzo71, 41124, Modena, Italy. brunomeduri@gmail.com.
Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy. brunomeduri@gmail.com.
ORCID: 0000-0002-7588-9081

Ciro Franzese (C)

Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy.

Davide Franceschini (D)

Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy.

Pierfrancesco Franco (P)

Department of Oncology, University of Turin, Turin, Italy.
Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy.

Nadia Pasinetti (N)

Radiation Oncology Service, ASST Valcamonica Esine and Brescia University, Brescia, Italy.
Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy.

Valentina Lancellotta (V)

Dipartimento di Diagnostica per Immagini, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Radioterapia Oncologica ed Ematologia, Roma, Italia.
Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy.

Patrizia Giacobazzi (P)

Radiation Oncology Unit, University Hospital of Modena, Via del pozzo71, 41124, Modena, Italy.

Eliana La Rocca (E)

Radiotherapy Unit 1, Fondazione I.R.C.C.S Istituto Nazionale Tumori di Milano, Milano, Italy.

Elisa D'Angelo (E)

Radiation Oncology Unit, University Hospital of Modena, Via del pozzo71, 41124, Modena, Italy.

Laura Lozza (L)

Radiotherapy Unit 1, Fondazione I.R.C.C.S Istituto Nazionale Tumori di Milano, Milano, Italy.

Lorenzo Livi (L)

Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy.
Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.

Icro Meattini (I)

Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Firenze, Italy.
Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy.
Clinical Oncology Breast Cancer Group (COBCG), Firenze, Italy.

Marta Scorsetti (M)

Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milano, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Maladies du sein › Tumeurs du sein › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Maladies du sein › Tumeurs du sein › Carcinome canalaire du sein › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Tumeurs › Tumeurs par type histologique › Tumeurs épithéliales épidermoïdes et glandulaires › Tumeurs canalaires, lobulaires et médullaires › Carcinome intracanalaire non infiltrant › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études de suivi › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Procédures de chirurgie opératoire › Mastectomie › Mastectomie partielle › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Comparing hypofractionated and conventionally...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Processus néoplasiques › Récidive tumorale locale › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Diagnostic › Pronostic › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Thérapeutique › Radiothérapie › Dosimétrie en radiothérapie › Fractionnement de la dose d'irradiation › Hypofractionnement de dose › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Thérapeutique › Radiothérapie › Radiothérapie adjuvante › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Comparing hypofractionated and conventionally...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Taux de survie › Comparing hypofractionated and conventionally...