Purpose Weekly irradiation in breast cancer in elderly patients is a treatment option, whose tolerance may be influenced by the fractionation used. The objective of this study is to compare the tolerance and long-term side effects of two different fractionations. Materials and methods 47 elderly patients were recruited after conservative or radical treatment that also received irradiation with a dose per fraction of 6.25 Gy or 5 Gy for one session per week, 6 sessions in total. The long-term tolerance results are compared by assessing toxicity using CTCAE version 5.0 scales for dermatitis, telangectasia, fibrosis and pain of the irradiated breast. In addition, objective parameters of skin status (erythema, hyperpigmentation, elasticity and hydration) by a multi-probe MultiSkin Test-Center system were obtained and compared between groups. Results After an average follow-up of 5 years, all patients were free of disease and with complete local control. A total of 20 patients with 6.25 Gy fractionation and 27 patients with 5 Gy fractionation have been included. Patients treated with lower fractionation had a lower incidence of dermatitis, telangectasia, fibrosis, or local pain. The decrease in elasticity measured by the multi-probe system was smaller with the fractionation of 5 Gy. No differences were observed in the other objective parameters. Conclusion Weekly irradiation with 5 Gy fractionation is better tolerated than with higher fractionation.

Dysphagia is a common toxicity of head and neck radiation therapy in patients undergoing chemoradiotherapy (CRT). There are discrepancies between the parameters by the instrumental methods and the perceptions of the patient. The objective of this study is to correlation the 10-item feeding assessment tool (EAT-10) for swallowing disorders, and the Penetration-Aspiration Scale (PAS) score obtained by videofluoroscopy, visual analogic scale (VAS) and functional oral intake scale (FOIS) within 3 months after treatment. We evaluated 46 patients included in "Redyor" study, measured at baseline (diagnosis), before and after initiating CRT, and at 3-month follow-up, were EAT-10, visual analogic scale (VAS) for self-impaired swallow, dysphagia assessed with PAS, functional oral intake scale (FOIS), maximal interincisor opening, and maximum isometric tongue pressure. Who had the EAT-10 test before, the end and 3 months after the treatment, to evaluate the relationship between PAS, VAS, and FOIS. A receiver operating characteristic (ROC) curve determined for the cut-off of the EAT-10. The Spearman correlation coefficients were calculated. A p <0.05 bilateral was considered statistically significant. Functional and self-perception values decreased in weeks 6 to 9 after CRT, coinciding with the worst EAT-10 score. A receiver operating characteristic (ROC) curve determined 3 cut-off points (with their respective sensitivity and specificity): baseline, 3 (86%, 77%); post-CRT, 15 (62.5%, 80%); and 3-month follow-up, 4 (83%, 75%). A strong correlation between VAS, FOIS, and EAT-10 observed at baseline subsequently disappeared. Table 1. New cut-off points for EAT-10 are suggested during the treatment. Our findings confirm the poor relationship between EAT-10 and the instrumental methods and highlight the need to optimize the use of tools to detect and monitor dysphagia in this cohort of patients with high risk of bronchoaspiration EAT-10, Eating Assessment Test; PAS, Penetration-Aspiration scale; VAS visual analogic scale for self-perception swallowing disturbances. Swallowing Rehabilitation in Patients With Head and Neck Cancer Receiving Radiotherapy (ReDyOR) NCT02900911.Abstract 2838; Table 1Spearman correlation coefficients (r) between EAT-10 and PAS, FOIS and VAS in the study periodPASFOISVASBefore chemoradiotherapy (basal)0.314; p=0.0550.340; p=0.0370.451; p=0.005After chemoradiotherapy0.329; p=0.1450.127; p=0.5820.254; p=0.2673-months post-chemoradiotherapy0.275; p=0.3030.008; p=0.9760.005; p=0.987 Open table in a new tab

The weekly irradiation in breast cancer patients of advanced age is an option of treatment which tolerance can be influenced by the fractionation utilized. We analyze the long-term results of two weekly schedules. Between 1992 and 2016, we included 486 elderly patients presenting concomitant pathology or socio-familial problems in which it was not feasible to propose conventional treatment. They were treated with conservative surgery (or mastectomy in some cases) and then adjuvant hypofractionated irradiation, administering 5 Gy or 6.25 Gy in 6 fractions, once a week (total dose 30–37.5Gy) over 6 weeks. Both long-term fractionations have been compared in a cohort of 46 patients. Long term efficacy is evaluated as well as the chronic toxicity by means of scales of the CTCAE version 5.0 as for dermatitis, telangiectasia, fibrosis, and pain. Objective parameters of skin quality have been evaluated by means a multiprobe system, MultiSkin Test Center, measuring erythema, pigmentation, elasticity, and hydration. Median follow-up was 6 years. Overall survival according to the Kaplan-Meier method at 5 years was 74.2%±2.3%; breast cancer disease-free survival was 90%±1.6%; local relapse-free survival was 96.5%±1% showing that patients die more from other causes and not from their neoplasia. Acute dermatitis was mild (75.6% of the patients, grades I–III) and 30.6% had moderate chronic fibrosis. In the cohort of longer survivors, patients received doses of 6.25 Gy in 21 cases and 5 Gy in 25 cases. Patients treated with smaller dose presented lower incidence of dermatitis, telangiectasias fibrosis, or local pain. Diminish in elasticity measured by multiprobe system was also less marked in patients receiving doses of 5 Gy. There were no differences in the other parameters of skin quality at long term. Once-weekly hypofractionated radiotherapy is feasible and convenient option for elderly patients with breast cancer. It is a safe treatment modality with similar survival and local control results compared to standard fractionation, while the side effects are acceptable. Weekly irradiation at a 5 Gy per dose is equal in terms of efficacy but better tolerated compared to a superior dose schedule.