الفهرس 
Introduction and Aim of The WorkOnly 14 pages are availabe for public view
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Abstract
This prospective study included 100 patients with high risk breast cancer presented to Clinical Oncology Department, Menoufia University Hospital during the period from May 2011 to December 2011 and indicated for postmastectomy radiotherapy after finishing adjuvant chemotherapy. Eligible patients were randomized into two treatment group either to receive radiotherapy with 40 Gy in 15 fractions through 3 weeks or same schedule with concurrent capecitabine 825 mg/m2 every 12 hours on radiotherapy days. In this study we aimed to evaluate the safety, feasibility and efficacy of concurrent capecitabine with adjuvant hypofractionated radiotherapy, patients were assessed for treatment related toxicity and disease recurrence, the median follow up duration was 24 months.
Generally, the incidence of acute and late toxicities were comparable in both treatment groups with no incidence of serious adverse effects with capecitabine, only mild increase in GIT side effects were noticed, however, concurrent capecitabine was highly tolerable and feasible; (96%) of the patients were able to finish their concurrent capecitabine therapy and all patients finished radiotherapy (100%) the radiation dose was not attenuated or interrupted by the addition of capecitabine.
The incidence of early treatment related toxicities; radiation dermatitis, acute radiation pneumonitis, treatment related fatigue and hematological toxicities (anemia is the only detected) were comparable between both treatment groups. All early toxicities were GI/GII. Other adverse effects as cardiac ischemic attacks, hand and foot syndrome, hepatic and renal toxicities were absent.
The incidence of late skin and subcutaneous tissue toxicities; chest wall pain and/or tenderness, skin dyspigmentation, subcutaneous tissues fibrosis/fat necrosis and lymphedema were comparable in both treatment groups and most of them were GI/II. No observed cardiac adverse effects, symptomatic rib fracture, telangiectasia, radiation induced brachial plexopathy, symptomatic lung fibrosis and other late toxicities in both groups during this phase of follow-up period.
As regard efficacy, at 2 year, concurrent capecitabine arm had better disease control locally and systemically; no incidence of isolated locoregional recurrence versus one isolated chest wall recurrence with radiotherapy only arm, one patient in each treatment group had locoregional recurrence associated with systemic failure, the incidence of distant metastasis is lower in the concurrent capecitabine group with 12% versus 16% in radiotherapy only group. There was a trend to improvement of DFS with addition of capecitabine but the difference was statistically insignificant.
Conclusion: the addition of concurrent capecitabine to hypofractionated adjuvant postmastectomy radiotherapy is highly safe, feasible with most of the patients completing all their treatment, 100% for radiotherapy and 96% for capecitabine and didn’t lead to radiation dose attenuation or interruption. Most of toxicities were GI/II, with no observed serious adverse effects. As regard to efficacy there was a trend to improvement of DFS with use of concurrent capecitabine but the difference was statistically insignificant, we recommend longer follow up to clarify these results.