Evaluating Loco-Regional Hypofractionated versus Conventional Radiotherapy in Post-Mastectomy Breast Cancer

Abstract

Background :Hypofractionated radiotherapy (HFRT) has emerged as a cost-effective and logistically favorable alternative to conventional fractionated radiotherapy (CFRT) in the treatment of breast cancer, particularly in resource-limited settings. This study aimed to compare loco-regional toxicities and treatment outcomes between HFRT and CFRT in post-mastectomy breast cancer patients in Bangladesh.

Methods:A quasi-experimental, comparative study was conducted among 60 post-mastectomy breast cancer patients, divided equally into Arm A (CFRT) and Arm B (HFRT). Socio-demographic, clinical, tumor-related, treatment-related characteristics, and radiotherapy-induced toxicities were assessed and compared. Data were analyzed using appropriate statistical tests, with a p-value < 0.05 considered significant.

Results:The mean age of participants was similar across both groups. Significant differences were observed in monthly income, BMI, ECOG performance status, tumor grade, and pathological staging (p < 0.05). Acute skin toxicity (Grade II/III) was more frequent in CFRT (23.3%) compared to HFRT (10%), though not statistically significant (p > 0.05). Chronic dermatitis and esophageal toxicities were also higher in CFRT. Lymphedema, pulmonary, and cardiac toxicities were mild and comparable. Besides, HFRT displayed a substantial cost reduction (86,900 BDT compared to 1,33,250 BDT in CFRT). Lastly, no Grade IV toxicities were reported in either group.

Conclusion:HFRT offers equivalent safety and tolerability to CFRT with the added advantages of shorter treatment duration, improved compliance, and reduced cost. In high-patient-load, low-resource settings like Bangladesh, HFRT can

be an effective alternative to CFRT in post-mastectomy breast cancer treatment. Long-term, multicenter studies are recommended to assess survival and loco-regional control outcomes