Abstract
Background and purpose
Unlike squamous carcinomas, breast adenocarcinoma may be as sensitive to fraction
size as late dose-limiting normal tissues. If so, fewer larger fractions would be
as safe and effective as regimens based on 2.0 Gy fractions. The first step is to test the effects of radiotherapy fractions >2.0 Gy on late normal tissue responses in the breast after tumour excision and radiotherapy
for early breast cancer.
Patients and methods
One thousand four-hundred and ten women with T1-3 N0-1 M0 invasive breast cancer were
randomised between 1986–98 into one of three radiotherapy regimens after local tumour
excision of early stage breast cancer; 50 Gy in 25 fractions (F) vs two dose levels of a test schedule giving 39 or 42.9 Gy in 13 F over 5 weeks. Fraction sizes were 2.0, 3.0 and 3.3 Gy, respectively. The primary endpoint was late change in breast appearance compared
to post-surgical appearance scored from annual photographs blinded to treatment allocation.
Secondary endpoints included palpable breast induration (fibrosis) and ipsilateral
tumour recurrence.
Results
After a minimum 5-year follow up, the risk of scoring any change in breast appearance
after 50 Gy/25 F, 39 Gy/13 F and 42.9 Gy/13 F was 39.6, 30.3 and 45.7%, from which an α/β value of 3.6 Gy (95% CI 1.8–5.4) is estimated. The α/β value for palpable breast induration was 3.1 Gy (95% CI 1.8–4.4).
Conclusions
An α/β value of around 3 Gy for late normal tissue changes in the breast is derived from the estimated equivalence
of 41.6 Gy in 13 fractions and 50 Gy in 25 fractions over 5 weeks, in line with trial predictions.
Keywords
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Article info
Publication history
Accepted:
January 26,
2005
Received in revised form:
January 17,
2005
Received:
July 28,
2004
Identification
Copyright
© 2005 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
