Late normal tissue effects in the arm and shoulder following lymphatic radiotherapy: Results from the UK START (Standardisation of Breast Radiotherapy) trials

Adjuvant lymphatic radiotherapy (LNRT) is recommended for selected axillary node positive women with early breast cancer. We investigated whether hypofractionated LNRT is safe combined with similarly-hypofractionated breast/chest wall radiotherapy (RT). The Standardisation of Breast Radiotherapy (ST...

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Bibliographic Details
Published in:Radiotherapy and oncology 2018-01, Vol.126 (1), p.155-162
Main Authors: Haviland, Joanne S, Mannino, Mariella, Griffin, Clare, Porta, Nuria, Sydenham, Mark, Bliss, Judith M., Yarnold, John R.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arm - radiation effects
Breast cancer
Breast Neoplasms - radiotherapy
Female
Humans
Hypofractionation
Lymph nodes
Lymphatic Irradiation - adverse effects
Lymphatic Irradiation - methods
Middle Aged
Normal tissue effects
Radiation Dose Hypofractionation
Radiation Injuries - etiology
Radiotherapy
Radiotherapy, Adjuvant
Shoulder - radiation effects
United Kingdom
Young Adult
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Summary:Adjuvant lymphatic radiotherapy (LNRT) is recommended for selected axillary node positive women with early breast cancer. We investigated whether hypofractionated LNRT is safe combined with similarly-hypofractionated breast/chest wall radiotherapy (RT). The Standardisation of Breast Radiotherapy (START) pilot, A and B trials randomised women with early breast cancer to schedules of 2.67–3.3 Gy versus 2.0 Gy fractions (control). RT adverse effects were assessed by patients using the EORTC QLQ-BR23 and protocol-specific questions, and by physicians. Rates of arm/shoulder effects were compared between schedules for patients given LNRT. 864/5861 (14.7%) patients received LNRT (385 START-pilot, 318 START-A, 161 START-B). Prevalences of moderate/marked arm/shoulder effects were low up to 10 years. There were no significant differences between the hypofractionated and control groups for patient- and physician-assessed symptoms in START-A or START-B. In START-pilot, adverse effect rates were higher after 13 fractions of 3.3 Gy, consistent with effects reported in the breast/chest wall (significant for shoulder stiffness, HR 3.07, 95%CI 1.62–5.83, p = 0.001). The START trial results suggest that appropriately-dosed hypofractionated LNRT is safe in the long-term, according to patient and physician-assessed arm and shoulder symptoms. These findings are consistent with those reported after the same schedules delivered to the breast/chest wall.
ISSN:0167-8140
1879-0887
DOI:10.1016/j.radonc.2017.10.033