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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Embargo End Date
Authors
Haviland, JS
Mannino, M
Griffin, C
Porta, N
Sydenham, M
Bliss, JM
Yarnold, JR
START Trialists' Group,
Mannino, M
Griffin, C
Porta, N
Sydenham, M
Bliss, JM
Yarnold, JR
START Trialists' Group,
Document Type
Journal Article
Date
2018-01-01
Date Accepted
2017-10-29
Abstract
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.
Citation
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2018, 126 (1), pp. 155 - 162
Source Title
Publisher
ELSEVIER IRELAND LTD
ISSN
0167-8140
eISSN
1879-0887
Collections
Research Team
Clinical Trials & Statistics Unit