Hypofractionated Adjuvant Radiation Therapy Is Effective for Patients With Lymph NodeePositive Breast Cancer: A Population-Based Analysis

Purpose This study evaluated long-term, population-based, breast cancerspecific outcomes in patients treated with radiation therapy (RT) to the breast/chest wall plus regional nodes using hypofractionated (HF) (40-42.5 Gy/16 fractions) versus conventionally fractionated (CF) regimens (50-50.4 Gy/25-28 fractions). Methods and Materials A prospective provincial database was used to identify patients with lymph nodepositive breast cancer treated with curative-intent breast/chest wall + regional nodal RT from 1998 to 2010. The effect of RT fractionation on locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and breast cancerspecific survival (BCSS) was assessed for the entire cohort and for high-risk subgroups: grade 3, ER/HER2, HER2+, and =4 positive nodes. Multivariable analysis and 2:1 case-match comparison of HF versus CF were also performed. Results A total of 5487 patients met the inclusion criteria (4006 HF and 1481 CF). Median age was 55 years, and median follow-up was 12.7 years. On multivariable analysis, no statistically significant differences were identified in 10-year LRRFS (hazard ratio [HR] 0.87; 95% confidence interval [CI], 0.59-1.27; P = .46), DRFS (HR 0.90; 95% CI, 0.76-1.06; P = .19), or BCSS (HR 0.92; 95% CI, 0.76-1.10; P = .36) between the HF and CF cohorts. There was no statistical difference in breast cancerspecific outcomes in the high-risk subgroups. On analysis of 2962 HF cases matched to 1481 CF controls, no statistical difference was observed in LRRFS (HR 0.98; 95% CI, 0.71-1.33; P = .87), DRFS (HR 0.97; 95% CI, 0.85-1.11; P = .68), or BCSS (HR 1.00; 95% CI, 0.87-1.16; P = .92). Conclusions This large, population-based analysis with long-term follow-up after locoregional RT demonstrated that modest HF provides similar breast cancerspecific outcomes compared with CF. HF is an effective option for patients with stage I to III breast cancer receiving nodal RT. (C) 2020 Elsevier Inc. All rights reserved.