Quality of life following conventional and hypofractionated radiotherapy using three-dimensional conformal radiotherapy in postmastectomy breast carcinoma: A prospective comparative study

Background: Hypofractionated radiotherapy (HF-RT), delivering doses >2 Gy per fraction over 3-4 weeks, has gained popularity due to reports suggesting a lower α/β ratio (2-4) for breast cancer, supporting its radiobiological equivalence to conventional fractionated radiotherapy (CF-RT). Objectives: The primary objective was to compare quality of life (QOL) between HF-RT and CF-RT to the chest wall in postmastectomy patients with breast cancer. The secondary objective was to compare the radiation toxicity profiles between the two arms. Materials and Methods: In this prospective comparative study (April 2021 and July 2022) conducted in the Department of Radiation Oncology, 52 treatment-naïve postmastectomy patients aged 18-70 years indicated for adjuvant radiotherapy were randomized to CF-RT (50 Gy total dose in 2 Gy daily dose) or HF-RT (40 Gy total dose in 2.67 Gy daily dose). QOL was assessed at baseline, at end of treatment, and on follow-up using EORTC QLQ-C30 and QLQ-BR23 questionnaires. Results: Baseline clinical and tumor characteristics were comparable, and treatments were well tolerated across both the groups. QOL scores showed transient worsening at radiotherapy completion, which improved with follow-up in both arms. Fatigue and pain were the most common symptoms at treatment completion (fatigue score: 22.2 vs 16.6; pain score: 16.6 vs 16.6 in CF-RT vs HF-RT). Breast-related symptom scores in both the arms were high at baseline and post treatment (16.6 vs 8.3) but declined significantly by the last follow-up. Conclusion: HF-RT was comparable to CF-RT in terms of QOL outcomes and toxicity for chest wall irradiation in patients with postmastectomy breast cancer.