Tratamiento del cáncer de mama en pacientes de edad avanzada con radioterapia hipofraccionada semanal

Abstract

Objective: The objective of this study is to analyze the results of weekly hypofractionated radiotherapy in elderly patients and to compare the results of two different dose schedules in order to find the most appropriate schedule._x000D_ _x000D_ Material and methods: Between 1992 and 2016, 486 elderly patients with concomitant pathology or socio-family problems were included. Conservative surgery or mastectomy and then hypofractionated irradiation were performed, administering 6.25 Gy in 6 fractions, once a week, total dose 37.5 Gy for 6 weeks, starting in August 2012, with the intention of reduce chronic toxicity, the treatment scheme was changed to 6 fractions of 5 Gy, total dose of 30 Gy. For the analysis of long-term toxicity, we have been able to recruit 20 patients who received 37.5 Gy and 27 patients who received 30 Gy. Long-term tolerance was evaluated using the CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis, and irradiated breast pain, as well as an objective measurement of erythema, hyperpigmentation, elasticity and hydration of the skin using the Multi-system. Skin-Center (MC750-B2; CK electronicGmbH)._x000D_ _x000D_ Results: The 5 year overall survival probability of the entire series, according to the Kaplan-Meier method, was 74.2% ± 2.3%; the probability of disease-free survival was 90% ± 1.6%; local relapse-free survival was 96.5% ± 1% and cause-specific survival was 90% ± 1.6%. Acute dermatitis was mild (75.6% of grade I to III patients) and 30.6% had moderate chronic fibrosis. After an average follow-up of 6 years, the patients treated with the dose per minor fraction (5 Gy x 6 sessions) had a lower incidence of dermitis, telangectasia, fibrosis or local pain. The decrease in elasticity measured by the multiple probe system was also less with the 5 Gy fractionation. No differences were observed in the other objective parameters.

Date of Award	17 Dec 2020
Original language	Spanish
Supervisor	Manuel Ignacio Algara Lopez (Director), Xavier Sanz Latiesas (Director) & Ramon Maria Pujol Vallverdu (Tutor)