What hypofractionated palliative radiation regimens are safe and effective for advanced, inoperable breast cancer? Two phase I/II trials from Tata Medical Center evaluated two palliative regimens for patients with symptomatic, advanced primary breast tumors who were not candidates for definitive therapy. Both trials treated the whole breast and the supraclavicular fossa. Trial A (n=28) delivered 35 Gy in 10 fractions and trial B (n=30) delivered 26 Gy in 5 fractions over 1 week. In the latter, VMAT was used to also deliver a simultaneous integrated boost to the gross tumor of 32 Gy. All patients had either stable or improved symptoms after treatment with significant reductions in bleeding, ulceration, and fungation. The radiographic response rate was >80%. Acute toxicity was mild with no grade 3 toxicity in the 10 fraction trial and a rate of 8% in the 5 fraction trial that was resolved by 3 months. At the end of treatment the rate of grade 2 toxicity was 4% in the 10 fraction trial and 10% in the 5 fraction trial. At 1 year, 90% of patients had symptom control in the treatment site. | Chatterjee, Int J Radiat Oncol Biol Phys 2023
