Post Mastectomy Radiotherapy in Ca Breast A Comparison of Three Protocols

Abstract

This trial was designed to compare three hypofractionated protocols in postmastectomy cancinoma breast in terms of local control, toxicity & work load. A total of three hundred patients suffering from ca breast stage T2-4 , N any, M0 were randomized into three arms after mastectomy. All the patients were treated with four fields on Co60 i.e. two tangential portals for chest wall, one anterior supraclavicular & axillary field & a posterior axillary boost and were randomized into three arms i.e. 2700 CGy in 5 fractions (one week) arm A, 3500 CGy in 10 fractions (2 weeks) arm B and 4000 CGy in 15 fractions (3 weeks) arm C. Skin, cardiac, pulmonary and hematological toxicities & lymphedema were compared in addition to local control and work load. The locoregional relapses were 11%, 12% and 10% in arms A, B & C respectively. 26%, 24% & 28% patients developed metastatic disease and 17%, 18% & 20% died in the three arms. G3 & G4 skin toxicities were 37%, 28% & 14%. G2 and G3 lymphedema was 21%, 22% & 27%. Cardiac toxicity was 5%, 6% & 5% while pulmonary toxicity was 4%, 5% & 5% respectively. All the differences except skin toxicity were statistically insignificant. There were no cases of hematological depression or rib fractures. All the three short protocols were equally effective in locoregional disease control and toxicity was also comparable. They were helpful in reducing the work load and can be safely recommended for routine clinical use.