Intensification of radiation therapy for localized breast cancer in the context of the COVID-19 pandemic.

Abstract

Relevance. According to statistics, breast cancer (BC) in the Republic of Kazakhstan ranks first in the structure of the incidence of malignant neoplasms of both sexes of the population with a proportion of 14.5% (in 2019 - 15.2%). This situation has been stable since 2004, in addition, breast cancer is in first place and constantly occupies this position in the structure of female oncopathology - 44.3%000 (in 2019 - 51.6%000). In the early 1980s, radiation therapy was used as the standard for specialized breast cancer treatment. The current realities in the context of the COVID-19 pandemic dictated to us the rules according to which a reorganization of health care facilities is necessary to determine priorities, but also an important question arose about the economic and clinical balance of the effectiveness of the method of radiotherapy. In this literature review, we reviewed key randomized trials of hypofractionated radiation therapy, with particular emphasis on adequate patient selection as reflected in the American Society of Therapeutic Radiology and Oncology (ASTRO) guidelines, and on the radiobiological aspects of hypofractionation in relation to its implementation in the conditions of the clinic.

The purpose of the study was to analyze the results of key randomized trials and compare the results of breast cancer treatment using different hypofractionation (HF) and standard fractionation (SF) regimens.

Results: According to the results of key randomized trials, the hypofractionated regimen does not differ from the standard regimen in terms of late effects on the part of normal tissues, and at the same time, good control over the oncological process is achieved.

Conclusions: HF has proven its effectiveness and safety, and also shows even better late and/or acute radiation toxicity after the treatment of breast cancer in the early stages and may become the new standard of radiation therapy in the early stages after breast-conserving surgery.