Abstract

Abeid Mohamed Athman Omar¹, Azza Mohamed Amin Darwesh¹

¹Faculty of medicine, Alexandria University, Alexandria Clinical Oncology and Nuclear Medicine Department (ACOD), Alexandria, Egypt

Since the beginning of coronavirus disease (COVID-19), there is a compelling reason for the use of hypofractionated radiotherapy (HFRT) schedules in cancer management to safeguard the patients and the treating physicians. However, conflicting data shows that young breast cancer (BC) patients have a higher locoregional relapse after breast-conservative surgery (BCS). Given this, we aim to compare the locoregional control between conventional radiotherapy (CRT) and HFRT after BCS in a cohort of young BC patients.

We retrospectively reviewed stage I-III BC patients in two centers diagnosed between 2008 and 2017 who underwent BCS and had follow-up data. Patients were categorized into two groups: CRT (50Gy in 25 fractions) vs. HFRT (40.5 - 42.5 Gy in 15-16 fractions). Boost was added to all patients.

247 patients were included in this analysis. Among them, 87 (35%) received CRT, while 160 (65%) were treated by HFRT. The clinicopathological characteristics of CRT vs. HFRT were as follows: The majority of the patients were T1 and T2, 92% in CRT vs. 94% in HFRT. N3 was rare in both groups, 8.3% vs. 5.1% in CRT vs. HFRT, respectively. The CRT had more stage 3 patients than HFRT, 35% vs. 23% respectively, but fewer stage 1 (18.1 vs. 23.5%, respectively). Estrogen/progesterone receptor (ER/PR) positive was 79.5% vs. 76.7%, HER2 enriched was 7% vs. 5%, while high Ki-67 was 56.3% vs. 71.4% in CRT vs. HFRT, respectively. Lymphovascular invasion was positive in 52.7% of CRT vs. 64.3% in HFRT, while the extracapsular extension was positive in 31% of CRT vs. 19.4% in HFRT. The distribution of tumor grades was similar across the groups. After a median follow up of 42 months (range: 5-135), 10% of the total 247 patients developed locoregional recurrences:13.8% (n=12) were in CRT group, whereas 8.1% (n=13) in HFRT, p = 0.158; the HFRT group had insignificant lower locoregional recurrences. In univariate and multivariate analysis, only very young age was an independent poor prognostic factor for locoregional failure.

We found no significant differences in locoregional control between CRT and the HFRT following BCS among young BC patients. In this COVID-19 pandemic, HFRT should also be considered in young BC patients to shorten the treatment time.