A Pilot Study of the Egyptian Experience of Hypofractionation in Patients with Breast Cancer Treated with Mastectomy

Purpose: To compare three fractionation schedules in post mastectomy patients treated with radiotherapy as regard acute and early late effects as well as local recurrence rates. Patients and Methods: Between November 2001 and July 2004, 107 breast patients treated with modified radical mastectomy and adjuvant radiotherapy ± adjuvant systemic treatments were enrolled in this study. Patients were categorized into three groups. Group A (41 patients) received conventional fractionation 50Gy over 25 fractions. Group B (36 patients) received other fractionation regimen 45Gy over 17 fractions. Group C (30 patients) received 40Gy over 15 fractions. The median follow up period was 23 months. Results: There has been no statistical significant difference in local control (p=0.88), pain (p=0.98), telangectasis (p=0.23), fibrosis (p=0.13), arm oedema (p=0.96) or pigmentation (p=0.80) between the three groups. GII-III Erythema was significantly higher in the two hypofractionation arms compared to the control arm (p=0.001). Conclusion: Our study demonstrates the feasibility of delivering a hypofractionation radiotherapy protocol to Egyptian patients with breast cancer following mastectomy. Local breast cancer recurrence rates and late radiation effects are similar to Western populations but there is a significant increase in acute skin reactions. A national randomized multicentre study is needed to examine this in detail before drawing conclusions about shifting to hypofractionation regimen in the adjuvant treatment of breast cancer.