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FULL VersionA class of women with early-onset breast cancer (EORTC trial 22931) treated with three-dimensional conformal radiotherapy and dynamic treatment strategies. To report the treatment outcome and treatment toxicity of postmenopausal women with early-onset breast cancer treated with three-dimensional conformal radiotherapy (3D-CRT) and dynamic treatment strategies. A total of 64 postmenopausal women with Stage IIA or IIB operable breast cancer with a median age of 60 years were included in this study. Three-dimensional conformal radiotherapy was delivered to the primary breast tumor and the regional lymph nodes, using two lateral fields for the chest wall, followed by three to four rotational fields for the internal mammary nodes. For the patients with an unfavourable ipsilateral axillary lymph node, the axillary field was reduced to a width of 2 cm. The median volume of the breast irradiated was 89.4 cm3 (range, 21.4-289.2 cm3), and the median dose of the chest wall was 54.0 Gy (range, 40.0-60.0 Gy). The median total dose of the internal mammary nodes was 54.0 Gy (range, 50.0-70.0 Gy). Patients were divided into three groups according to the dynamic treatment strategy: group A (n=17), only the internal mammary nodes received a dose higher than 50 Gy; group B (n=27), only the internal mammary nodes received a dose higher than 45 Gy and the primary breast tumor received a dose higher than 60 Gy; group C (n=14), both the internal mammary nodes and the primary breast tumor received a dose higher than 60 Gy. The median follow-up duration was 44 months. No patient experienced local recurrence. Two patients had regional recurrences, and the median relapse-free survival was 67 months. The overall 5-year actuarial local control, regional control, relapse-free survival and overall survival rates were 100%, 93.4%, 92.6% and 98.1%, respectively. The ipsilateral breast, lung, and heart contralateral to the tumor were the most common sites of the Grade 3 or higher late toxicity. The 5-year actuarial late toxicity rates were 37.5%, 0% and 7.1% for ipsilateral breast, lung and heart, respectively. Postmenopausal women with early-onset breast cancer can be treated with 3D
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