Hypofractionated Versus Conventional Fractionated Radiotherapy after Breast-Conserving Surgery in the Modern Treatment Era: A Multicenter, Randomized Controlled Trial from China

Shu Lian Wang, Hui Fang, Chen Hu, Yong Wen Song, Wei Hu Wang, Jing Jin, Yue Ping Liu, Hua Ren, Juan Liu, Gao Feng Li, Xiang Hui Du, Yu Tang, Hao Jing, Yu Chao Ma, Zhou Huang, Bo Chen, Yuan Tang, Ning Li, Ning Ning Lu, Shu Nan QiYong Yang, Guang Yi Sun, Xin Fan Liu, Ye Xiong Li

Research output: Contribution to journalArticlepeer-review

Abstract

PURPOSE No randomized trials have compared hypofractionated radiotherapy (HFRT) with conventional fractionated radiotherapy (CFRT) after breast-conserving surgery in the Asian population. This study aimed to determine whether a 3.5-week schedule of HFRT is noninferior to a standard 6-week schedule of CFRT in China. PATIENTS AND METHODS Patients from 4 Chinese institutions who had undergone breast-conserving surgery and had T1-2N0-3 invasive breast cancers participated this study. Patients were randomly assigned (1:1) using a computer-generated central randomization schedule, without stratification, to receive whole-breast irradiation with or without nodal irradiation, followed by tumor-bed boost, either at a dose of 50 Gy in 25 fractions over 5 weeks with a boost of 10 Gy in five fractions over 1 week (CFRT) or 43.5 Gy in 15 fractions over 3 weeks with a boost of 8.7 Gy in three daily fractions (HFRT). The primary endpoint was 5-year local recurrence (LR), and a 5% margin of 5-year LR was used to establish noninferiority. RESULTS Between August 2010 and November 2015, 734 patients were assigned to the HFRT (n 5 368) or CFRT (n 5 366) group. At a median follow-up of 73.5 months (interquartile range, 60.5-91.4 months), the 5-year cumulative incidence of LR was 1.2% in the HFRT group and 2.0% in the CFRT group (hazard ratio, 0.62; 95% CI, 0.20 to 1.88; P 5 .017 for noninferiority). There were no significant differences in acute and late toxicities, except that the HFRT group had less grade 2-3 acute skin toxicity than the CFRT group (P 5 .019). CONCLUSION CFRT and HFRT with a tumor-bed boost may have similar low LR and toxicity.

Original languageEnglish (US)
Pages (from-to)3604-3614
Number of pages11
JournalJournal of Clinical Oncology
Volume38
Issue number31
DOIs
StatePublished - Nov 1 2020

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Hypofractionated Versus Conventional Fractionated Radiotherapy after Breast-Conserving Surgery in the Modern Treatment Era: A Multicenter, Randomized Controlled Trial from China'. Together they form a unique fingerprint.

Cite this