Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial
Vakaet Vincent, MD,
Van Hulle Hans, PhD,
Van de Vijver Koen,
Hilderson Ingeborg,
Naert Eline,
De Neve Wilfried,
Vandorpe Jo,
Hendrix An,
Göker Menekse,
Depypere Herman,
Vergauwen Glenn,
Van den Broecke Rudy,
De Visschere Pieter,
Braems Geert,
Vandecasteele Katrien,
Denys Hannelore,
Veldeman Liv
Affiliations
Vakaet Vincent, MD
Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium
Van Hulle Hans, PhD
Dept. of Human Structure and Repair, Ghent University, Belgium; Corresponding author. University Hospital Ghent, Department of Radiotherapy, Entrance 98 Corneel Heymanslaan, 10 9000, Ghent, Belgium.
Van de Vijver Koen
Dept. of Pathology, Ghent University Hospital, Belgium; Dept. of Diagnostic Sciences, Ghent University, Belgium
Hilderson Ingeborg
Dept. of Medical Oncology, Ghent University Hospital, Belgium
Naert Eline
Dept. of Medical Oncology, Ghent University Hospital, Belgium; Dept. of Internal Medicine and Pediatrics, Ghent University, Belgium
De Neve Wilfried
Dept. of Human Structure and Repair, Ghent University, Belgium
Vandorpe Jo
Dept. of Pathology, Ghent University Hospital, Belgium; Dept. of Diagnostic Sciences, Ghent University, Belgium
Hendrix An
Dept. of Human Structure and Repair, Ghent University, Belgium
Göker Menekse
Dept. of Gynaecology, Ghent University Hospital, Belgium
Depypere Herman
Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium
Vergauwen Glenn
Dept. of Gynaecology, Ghent University Hospital, Belgium
Van den Broecke Rudy
Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium
De Visschere Pieter
Dept. of Diagnostic Sciences, Ghent University, Belgium; Dept. of Radiology and Nuclear Medicine, Ghent University Hospital, Belgium
Braems Geert
Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Gynaecology, Ghent University Hospital, Belgium
Vandecasteele Katrien
Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium
Denys Hannelore
Dept. of Medical Oncology, Ghent University Hospital, Belgium; Dept. of Internal Medicine and Pediatrics, Ghent University, Belgium
Veldeman Liv
Dept. of Human Structure and Repair, Ghent University, Belgium; Dept. of Radiation Oncology, Ghent University Hospital, Belgium
Objective: Neo-adjuvant radiotherapy (NART) for breast cancer has shown promising survival results in retrospective trials. However, there are some obstacles such as a chemotherapy delay, an increased overall treatment time (OTT) and the risk of increasing surgical morbidity. Accelerated radiotherapy (RT) in 5 fractions allows to deliver NART in a very short time span and minimizes the delay of surgery and chemotherapy. This trial investigates this NART schedule for safety, feasibility and OTT. Material and methods: Twenty patients eligible for neo-adjuvant chemotherapy (NACT) and breast conserving surgery, were randomized between NART before NACT or NACT and postoperative RT. In both arms, RT treatment was given in 5 fractions to the whole breast with a simultaneously integrated boost (SIB) on the tumor(bed). Lymph node irradiation was given concomitantly in case of lymph node involvement. OTT was defined as the time from diagnosis to last surgery in the intervention group, while in the control group the time between diagnosis and last RT-fraction was used. In the intervention group NACT-delay was defined as time between diagnosis and start of chemotherapy. Results: 20 patients were included, and 19 patients completed treatment. OTT was significantly shorter in the intervention group (mean 218 days, range 196–253) compared to the control group (mean 237, range 211–268, p = 0.001). The difference in mean duration from diagnosis to the first treatment was a non-significant 4 days longer (31 vs 27 days, p = 0.28), but the start of NACT after diagnosis was delayed by 21 days (48 vs 27 days, p < 0.001). NART did not result in additional surgery complications. Conclusion: This pilot trial is the first to report on accelerated NART in 5 fractions with SIB. NART before NACT resulted in a shorter OTT with good safety results.
