Late normal tissue effects in the arm and shoulder following lymphatic radiotherapy: Results from the UK START (Standardisation of Breast Radiotherapy) trials.
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Date
2018-01-01ICR Author
Author
Haviland, JS
Mannino, M
Griffin, C
Porta, N
Sydenham, M
Bliss, JM
Yarnold, JR
START Trialists' Group,
Type
Journal Article
Metadata
Show full item recordAbstract
BACKGROUND AND PURPOSE: 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). MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Collections
Subject
START Trialists' Group
Arm
Shoulder
Humans
Breast Neoplasms
Radiation Injuries
Radiotherapy, Adjuvant
Lymphatic Irradiation
Adult
Aged
Aged, 80 and over
Middle Aged
Female
Young Adult
United Kingdom
Radiation Dose Hypofractionation
Research team
Clinical Trials & Statistics Unit
Language
eng
Date accepted
2017-10-29
License start date
2018-01
Citation
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2018, 126 (1), pp. 155 - 162
Publisher
ELSEVIER IRELAND LTD