Jagsi R, Griffith KA, Boike TP, Walker E, Nurushev T, Grills IS, Moran JM, Feng M, Hayman J, Pierce LJ, et al.
JAMA oncology. Date of publication 2015 Oct 1;volume 1(7):918-30.
1. JAMA Oncol. 2015 Oct;1(7):918-30. doi: 10.1001/jamaoncol.2015.2590.
Differences in the Acute Toxic Effects of Breast Radiotherapy by Fractionation
Schedule: Comparative Analysis of Physician-Assessed and Patient-Reported
Outcomes in a Large Multicenter Cohort.
Jagsi R(1), Griffith KA(2), Boike TP(3), Walker E(4), Nurushev T(5), Grills
IS(6), Moran JM(7), Feng M(7), Hayman J(7), Pierce LJ(7).
Author information:
(1)Department of Radiation Oncology, University of Michigan, Ann Arbor2Center for
Bioethics and Social Science in Medicine, Ann Arbor.
(2)Center for Cancer Biostatistics, University of Michigan School of Public
Health, Ann Arbor.
(3)McLaren Northern Michigan, Petoskey.
(4)Henry Ford Hospital, Detroit, Michigan.
(5)21st Century Oncology, Detroit, Michigan.
(6)Beaumont Health System, Royal Oak, Michigan.
(7)Department of Radiation Oncology, University of Michigan, Ann Arbor.
Comment in
JAMA Oncol. 2015 Oct;1(7):941-2.
IMPORTANCE: Randomized trials have established the long-term safety and efficacy
of hypofractionated whole-breast radiotherapy, but little is known about the
acute toxic effects experienced by patients treated with hypofractionation as
compared with conventional fractionation, particularly in real-world settings and
from the patient's own perspective.
OBJECTIVE: To evaluate prospectively collected data on acute toxic effects and
patient-reported outcomes in a cohort treated with varying radiation
fractionation schemes in practices collaborating in the Michigan Radiation
Oncology Quality Consortium (MROQC).
DESIGN, SETTING, AND PARTICIPANTS: We compared toxic effects in patients
receiving hypofractionation (HF) vs conventional fractionation (CF) during
treatment (through 7 days after treatment) and in follow-up (posttreatment days
8-210), after adjustment for sociodemographic, clinical, and treatment
characteristics. The MROQC includes academic and community radiation oncology
practices across Michigan. All 2604 patients who received adjuvant whole-breast
radiotherapy after lumpectomy for unilateral breast cancer at MROQC participating
sites from October 2011 through June 2014 were registered; we analyzed 2309 for
whom there was a comprehensive physician toxicity evaluation within 1 week of
completion of radiotherapy and at least 1 weekly toxicity evaluation during
treatment.
EXPOSURES: Hypofractionation vs CF.
MAIN OUTCOMES AND MEASURES: Physicians reported dermatitis, pain, fatigue, and
other common toxic effects associated with breast radiotherapy at baseline,
weekly during radiotherapy, and in follow-up. Patients who consented also rated
their own experiences, including breast pain, fatigue, and being bothered by
symptoms.
RESULTS: Of the 2309 evaluable patients, 578 received HF. During treatment, after
adjustment for sociodemographic, clinical, and treatment factors, patients
receiving CF had significantly higher maximum physician-assessed skin reaction
(moist desquamation, 28.5% vs 6.6%, P < .001; grade ≥2 dermatitis, 62.6% vs
27.4%, P < .001), self-reported pain (moderate/severe pain, 41.1% vs 24.2%,
P = .003), burning/stinging bother (often/always, 38.7% vs 15.7%, P = .002),
hurting bother (33.5% vs 16.0%, P = .001), swelling bother (29.6% vs 15.7%,
P = .03), and fatigue (29.7% vs 18.9%, P = .02) but slightly greater absence of
skin induration in follow-up (84.5% vs 81.2%, P = .02). No significant
differences were observed in any other measured outcomes during follow-up
extending through 6 months.
CONCLUSIONS AND RELEVANCE: Hypofractionation not only improves convenience but
also may reduce acute pain, fatigue, and the extent to which patients are
bothered by dermatitis in patients with breast cancer undergoing whole-breast
radiotherapy.
DOI: 10.1001/jamaoncol.2015.2590
PMID: 26247417 [Indexed for MEDLINE]
