Header

UZH-Logo

Maintenance Infos

40/42 Gy in 13 fractions: a safe dose for the brachial plexus


Studer, G; Stocker, D N; Loewenich, K F; Glanzmann, C (2014). 40/42 Gy in 13 fractions: a safe dose for the brachial plexus. Journal of Nuclear Medicine & Radiation Therapy, 5(168):online.

Abstract

Aims: The use of hypo fractionated irradiation of the whole breast has regained much interest after the publication of the results of large randomized trials showing equivalent results as using standard fractionation (START A and B, randomized START pilot trials, Canadian trial). Due to the relatively low numbers of patients treated with hypofractionation to the supraclavicular ±axillary (S/A) region, the question of the brachial plexus tolerance continues to be discussed.
Aim of this work was to assess the high grade long term tolerance of the brachial plexus in our patients treated with 13x 3.3Gy to the S/A lymph nodes, in order to contribute to the question of plexus tolerance.
Materials and Methods: Between 1967 and 1977, 130 female breast cancer patients underwent postoperative hypo fractionated radiotherapy at the University Hospital Zurich. The most used schedule was 13x 3.3Gy midline dose, 3x/week (n=124) to the S/A region applied by equally rated antero-posterior/postero-anterior portals. A first assessment of the cohort was performed in 1994, which has been updated in December 2013. Patients with a follow up period <5 years or loco-regional disease have been excluded in 1994 (n=4, all without plexopathy). Pre-radiation surgery consisted of radical mastectomy in 98% and breast conserving operation in 2% of all patients, including axillary dissection. Pathological stage was pT1/2/3/4 in 28/58/10/4%; with pN0/pN+ in 57/43%. The mean/median follow up time of the cohort was 28.1/26.6 years (range, 7.2-44.8).
Results: One grade 2 brachial plexus neuropathy was observed.
Conclusion: The long term follow up in our patients corroborates the hypothesis of a total mid plane dose to the S/A region between 40-42Gy in 13 fractions being comparably safe as 25x 2.0Gy to 50Gy.

Abstract

Aims: The use of hypo fractionated irradiation of the whole breast has regained much interest after the publication of the results of large randomized trials showing equivalent results as using standard fractionation (START A and B, randomized START pilot trials, Canadian trial). Due to the relatively low numbers of patients treated with hypofractionation to the supraclavicular ±axillary (S/A) region, the question of the brachial plexus tolerance continues to be discussed.
Aim of this work was to assess the high grade long term tolerance of the brachial plexus in our patients treated with 13x 3.3Gy to the S/A lymph nodes, in order to contribute to the question of plexus tolerance.
Materials and Methods: Between 1967 and 1977, 130 female breast cancer patients underwent postoperative hypo fractionated radiotherapy at the University Hospital Zurich. The most used schedule was 13x 3.3Gy midline dose, 3x/week (n=124) to the S/A region applied by equally rated antero-posterior/postero-anterior portals. A first assessment of the cohort was performed in 1994, which has been updated in December 2013. Patients with a follow up period <5 years or loco-regional disease have been excluded in 1994 (n=4, all without plexopathy). Pre-radiation surgery consisted of radical mastectomy in 98% and breast conserving operation in 2% of all patients, including axillary dissection. Pathological stage was pT1/2/3/4 in 28/58/10/4%; with pN0/pN+ in 57/43%. The mean/median follow up time of the cohort was 28.1/26.6 years (range, 7.2-44.8).
Results: One grade 2 brachial plexus neuropathy was observed.
Conclusion: The long term follow up in our patients corroborates the hypothesis of a total mid plane dose to the S/A region between 40-42Gy in 13 fractions being comparably safe as 25x 2.0Gy to 50Gy.

Statistics

Altmetrics

Downloads

72 downloads since deposited on 25 Jun 2014
18 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Radiation Oncology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:25 Jun 2014 09:13
Last Modified:08 Dec 2017 06:11
Publisher:OMICS Publishing Group
ISSN:2155-9619
Publisher DOI:https://doi.org/10.4172/2155-9619.1000168

Download

Download PDF  '40/42 Gy in 13 fractions: a safe dose for the brachial plexus'.
Preview
Content: Published Version
Filetype: PDF
Size: 474kB
View at publisher