Headline: Hypofractionation appears safe following breast reconstruction.
The Study: Recall that most mature prospective data in this realm is on women with flat chest walls, although we recently saw a hypofractionated proton PMRT trial. The large, multicenter, prospective FABREC trial randomized 385 women with immediate placement of tissue expander or implant after mastectomy to either hypofractionation 42.56 Gy in 16 fractions versus standard 50 Gy in 25 fractions. There was no boost across the board though use of bolus and inclusion of regional nodes were at physician discretion. Hypofractionation did not significantly improve the primary endpoint of the Physical Well-Being domain of FACT-B at 6 months either overall or among preplanned subgroups stratified by age. However, the authors highlight there was no detriment in patient reported well-being nor in the rate of chest wall toxicity. Factors significantly associated with chest wall toxicity were primarily the presence of tissue expander versus implant (HR=7.74), preoperative endocrine therapy (HR=3.45), post-operative infection before radiation (HR=3.31),and number of LNs removed (HR=1.06/node).
TBL:In the FABREC trial, hypofractionated PMRT in patients with implant or tissue-expander reconstruction resulted in toxicity and quality of life outcomes comparable to conventional fractionation. | Wong, ASTRO 2023
The Study: Recall that most mature prospective data in this realm is on women with flat chest walls, although we recently saw a hypofractionated proton PMRT trial. The large, multicenter, prospective FABREC trial randomized 385 women with immediate placement of tissue expander or implant after mastectomy to either hypofractionation 42.56 Gy in 16 fractions versus standard 50 Gy in 25 fractions. There was no boost across the board though use of bolus and inclusion of regional nodes were at physician discretion. Hypofractionation did not significantly improve the primary endpoint of the Physical Well-Being domain of FACT-B at 6 months either overall or among preplanned subgroups stratified by age. However, the authors highlight there was no detriment in patient reported well-being nor in the rate of chest wall toxicity. Factors significantly associated with chest wall toxicity were primarily the presence of tissue expander versus implant (HR=7.74), preoperative endocrine therapy (HR=3.45), post-operative infection before radiation (HR=3.31),and number of LNs removed (HR=1.06/node).
TBL:In the FABREC trial, hypofractionated PMRT in patients with implant or tissue-expander reconstruction resulted in toxicity and quality of life outcomes comparable to conventional fractionation. | Wong, ASTRO 2023