Hypofractionation in Locally Advanced Breast Cancer: “Flash” Scheme

Abstract

Introduction: Breast cancer is a major cause of death in our country. The Department of Radiation Oncology of Portuguese Institute of Oncology in Coimbra are using a scheme of hypofraccionation called “Flash” as a treatment option for elderly patients or low performance status, with locally advanced breast cancer, or with stage IIb or IV, as a neoadjuvante or palliative aim. Objectives: Evaluation of the therapeutic response, for the group of patients selected, who did the hypofractionated schemed, in a retrospective study. Methods: Between January 2006 and December 2008, a total of 83 patients diagnosed with locally advanced breast cancer or with stage IIb or IV, were subjected to breast “Flash”. The radiation dose prescribed was 13Gy in 2 fractions in 3 days (in 23 patients – 27.7%) and 26 Gy in 4 fractions in 5 weeks (60 patients – 72.3%), with 4MV photons, in the sick breast. Global survival was evaluated using the Kaplan-Meier method. Statistical analysis was performed by applying the version 17.0 of SPSS and statistical tests were evaluated at a significance level of 5%. Results: 80 patients (96.4%) who have made breast “Flash” were female, aged between 59 and 93 years and performance status (Karnosfky scale) between 90 and 50%. In 72 patients (86.7%) the histology was invasive ductal carcinoma. Surgery was held in 53% of patients (44) after breast “Flash”, the radical modified mastectomy was the most common surgical technique. The diagnosis of bone metastasis was made in 10 patients (12%), while the global survival rate was 68.7% (57 patients). 10 patients (12%) died because disease progression or persistence. In 50.6% (42 patients) there was no evidence of disease progression and 3.6% (3 patients) showed clinical improvement. Conclusions: The “Breast Flash” is a safe treatment modality, in terms of secondary effects, and a valid therapeutic option for elderly patients or low performance status, with the diagnosis of locally advanced cancer or stage IIb or IV, as neoadjuvante, adjuvant or palliative aim. There is a little risk of relapse or progression in patients with good conditions, so the global survival rate is greater in these cases. There is a little iatrogenesis associated with this type of treatment; just one patient had grade III radiodermatitis.