Ultra-hypofractionated whole breast adjuvant radiotherapy in the real-world setting: single experience with 271 elderly/frail patients treated with 3D and IMRT technique

J Cancer Res Clin Oncol. 2022 Apr;148(4):823-835. doi: 10.1007/s00432-021-03907-w. Epub 2022 Jan 6.


Purpose: The purpose of the study was to evaluate the toxicity, local control, overall and disease-free survival of elderly breast cancer (BC) patients treated with adjuvant once-weekly ultra-hypofractionated radiotherapy (RT) either with intensity-modulated RT (IMRT) or 3D conformal RT (3DCRT).

Methods: From July 2011 to July 2018, BC patients receiving 5.7 Gy once a week for 5 weeks to the whole breast after breast-conserving surgery were considered for the study. Inclusion criteria were: T1-T3 invasive BC, no or limited axillary involvement, age ≥ 65 years or women with commuting difficulties or disabling diseases.

Results: A total of 271 patients were included in the study. Median age was 76 (46-86) years. Most of BC were T1 (77%), while the remaining were T2 (22.2%) and T3 (0.4%). Axillary status was negative in 68.3% of the patients. The only severe acute toxicity (G3) at the end of RT was erythema (0.4%), registered in the 3DCRT group; no G3 edema or epitheliolysis was recorded. With 18 months of median follow-up, severe early-late toxicity (G3) was reported in terms of fibrosis and breast retraction, both with an incidence of 1.4%, mostly in the 3DCRT group. Oncological outcomes at a median follow-up of 2.9 years reported 249/271 (91.9%) patients alive and free from any event and 5 (1.8%) isolated locoregional recurrences. At 3 years, disease-free survival and overall survival were 94.9% and 97.8%, respectively. Breast volume > 500 cm3 was reported as predictive for moderate-severe (≥ G2) acute toxicity.

Conclusions: Weekly ultra-hypofractionated whole breast RT seems feasible and effective. Toxicity was mild, local control was acceptable, and overall survival was 97.8% at 3 years. Rates of severe toxicity were reduced with the IMRT technique.

Keywords: 3DCRT; Breast cancer; IMRT; Once-weekly ultra-hypofractionated radiotherapy; Whole breast adjuvant radiotherapy.

MeSH terms

  • Aged
  • Breast Neoplasms* / etiology
  • Breast Neoplasms* / radiotherapy
  • Breast Neoplasms* / surgery
  • Female
  • Frail Elderly
  • Humans
  • Neoplasm Recurrence, Local
  • Radiotherapy, Adjuvant / methods
  • Radiotherapy, Conformal* / adverse effects
  • Radiotherapy, Conformal* / methods
  • Radiotherapy, Intensity-Modulated* / adverse effects