The purpose of the study is to investigate the difference in late radiation morbidity between hypofractionated and normofractionated loco-regional breast irradiation irrespective of mastectomy or lumpectomy. In patients who a candidates for a boost, the boost will be provided as a simultaneous integrated boost.
The randomization is between 50 Gy / 25 fractions and 40 Gy/15 fractions, 5 fractions weekly. In patients treated with boost 2 dose levels are accepted: 16 Gy/8 fractions and 10 Gy/5 fractions. These boost treatments will be provided as simultaneous integrated boost, where the overall treatment time in general is shortened 5 days. Thus the dose levels for boost patients are: 63 Gy / 51.52 Gy / 28 fractions, 57 Gy / 50 Gy / 25 fractions, 52.2 Gy / 42.3 Gy / 18 fractions, and 45.75 Gy / 40 Gy / 15 fractions. The primary endpoint is arm lymphedema 3 years after radiation therapy, but other late radiation morbidities will also be evaluated along with recurrence and sites of recurrence. Follow up of morbidity will continue for 10 years. The hypothesis is that women operated for early breast cancer with indication for loco-regional radiation therapy can be offered moderately hypofractionated therapy without developing more late radiation induced morbidity compared to normofractionated radiation therapy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
2,963
Aarhus University Hospital
Aarhus, Denmark
Development of ipsilateral arm lymphedema
\>=10% increased arm circumference compared to the other arm defines edema
Time frame: 3 years
Fibrosis grade 2-3
Breast or chest wall induration
Time frame: 3 years
Arm range of motion
Impaired shoulder movement is present when \>20 degrees difference between arms at flexion and/or abduction
Time frame: 3 years
Development of dyspigmentation
Grade 2 or worse dyspigmentation compared to baseline
Time frame: 3 years
Recurrence
Any recurrence location and time to event
Time frame: 10 years
Development of pain in the irradiated area
Pain in the irradiated area measured on visual analog scale compared to baseline
Time frame: 3 years
Change in sensibility
Change in sensibility in the irradiated area compared to baseline measured as yes/no
Time frame: 3 years
Development of edema on breast / chest wall
Grade 2 or worse edema
Time frame: 3 years
Development of telangiectasia in irradiated area
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Grade 2 or worse telangiectasia
Time frame: 3 years