Highly Accelerated Dose-Integrated Radiotherapy in 5 Fractions in Breast Cancer

Adjuvant radiotherapy in breast cancer improves local control, also in the elderly. Hormonal therapy in hormone sensitive tumors improves results but can not substitute radiotherapy. Improved local control leads to less breast cancer related morbidity and mortality, also in an older population (Schonberg, JCO, 2011). Unfortunately, in older patients with lower life expectancy, adjuvant radiotherapy is often omitted. Following reasons are invoked: * frailty of the patient * fear for toxicity * impaired mobility, rendering transportation and positioning more difficult * dependency for transportation to and from the radiotherapy departement * negative cost effectiveness ratio, due to high cost (especially for complex techniques and long schedules) and lower benefit (lower life expectancy) Hypofractionation is feasible without increased toxicity, and combines better local control with patient comfort and lower costs. Further lowering the number of fractions (from 15-21 to 5) will further improve patient comfort, but is challenging when different doses are needed in the same target volume. This problem is addressed using advanced techniques permitting dose-integration. In the elder with cancer, several unrecognized geriatric problems, including depression and cognitive impairment, can be detected by CGA . Some problems do interact with cancer treatment. In this study screening and assessment is provided to support patients and to develop an inventory of radiotherapy obstacles. Our study includes breast cancer patients, ≥70 years old, referred for adjuvant radiotherapy after surgical treatment. A schedule of 5 fractions is offered, encompassing different targets of treatment.

Sex

Female

Minimum age

70 Years

Inclusion Criteria:

* ≥ 70 years old
* AND breast conserving surgery or mastectomy for breast carcinoma
* AND multidisciplinary decision of adjuvant irradiation
* AND absence of distant metastases
* AND informed consent obtained, signed and dated before specific protocol procedures

Exclusion Criteria:

* Bilateral breast irradiation
* In case of mastectomy: positive resection margin, needing boost
* Mental condition rendering the patient unable to understand the nature, scope and possible consequences of the study
* Patient unlikely to comply with the protocol; i.e. uncooperative attitude, inability to return for follow-up visits, and unlikely to complete the study
* History of previous radiation treatment to the same region