الفهرس 
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Abstract
This prospective randomized two arm study included 116 female stage I
and II breast cancer patients who completed their postoperative
radiotherapy in the Radiation therapy and Nuclear Medicine department,
South Egypt Cancer Institute, in the period of time from January 2003 to
February 2005.
All patients were randomized into two groups, namely A and B. group A
included 54 patients who received conventional fractionation i.e. 2 Gy/
fraction, one fraction per day, five fractions per week for 5 weeks aiming
at 50 Gy total dose. group B consisted of 62 patients who received
hypofractionated radiotherapy in the form of 2.66 Gy per fraction, one
fraction per day, 5 fractions per week for 16 fractions given over 22 days
aiming to complete 42.5 Gy. All patients who had undergone CBS, in
either group, received an electron boost of 14 Gy, 2 Gy per fraction for
seven fractions a with 9-12 MV beam, except for those over fifty with a
negative margin.
For a median follow up of 24 months, survival and several acute and late
toxicity criteria were observed and analyzed for the two groups. Five,
9.3%, of group A, the conventional group, had local recurrence of the
disease and four, 7.4%, had distant metastases. For the hypofractionated
group, B, the results were similar having local recurrence occur in six
patients, 9.7% of the group, and distant metastases in four patients, 6.5% of
the group. The actuarial disease free survival was 83.3%±0.850 for the
conventionally treated group versus 83.9%±0.956 for the hypofractionated radiotherapy group. None of this data showed a statistically significant
difference between the two groups.
Skin changes were observed. Acute radiation dermatitis was observed and
graded in the two groups. The results were comparable in the two groups
showing no statistical difference. Grade 1 radiation dermatitis was
apparent in 26 patients of group 1, constituting 48.1% of the conventional
group, while it was manifested in 27, 43.5%, patients from the
hypofractionated therapy group. Grade 2 radiation dermatitis was found in
8 patients of group A, 14.8%, and 7 patients of group B, 11.3%.
Pulmonary toxicity was assessed by pulmonary function tests (PFT), chest
radiographs, and chest C.T. Fourty-five patients in group A (81.5%) and
53 patients of group B, (85.4% of the group) showed less than 10%
reduction of the pretreatment value of FVC and FEVı during the follow up
period, i.e. grade 0 toxicity. Four patients in each group showed chest
radiographic changes, making up 7.4% of group A and 6.5% of group B.
Nine patients in group A showed the infiltrates in the radiation fields (16.7
%). Also nine patients in group B showed radiation pneumonitis, 14.5%.
There was no statistical significant difference between the two groups
regarding the number of patients who manifested pulmonary toxicity.
Cardiac toxicity determined by function, assessed by the ejection fraction
measured by echocardiography, for left-sided breast cancer patients who
were 20 in group A and 30 in group B. The patients who experienced
cardiac toxicity were 4 in group A, constituting 20% of the group and 5
group B, 18% of the group. They were all graded as grade 1, (less than 10% decrease in the ejection fraction value), and were nonsymptomatic.
These results showed no statistically significant difference between group
A and B.