Disease Control After Delayed Adjuvant Radio Therapy Among Locally Advanced Breast Cancer Patients Treated After One Year Mastectomy At Tikur Anbessa Specialized Hospital In 2016 G.c.

Introduction – Nearly more than half of post mastectomy patient needs adjuvant radiotherapy.rnAdjuvant radiotherapy should be given according to clinical recommended indication, dose andrntime to reduce risk of loco-regional tumor recurrence. Most post mastectomy patients do not getrnadjuvant radiotherapy due to long radiotherapy waiting time at the centers. Delayed initiation ofrnadjuvant radiotherapy associated with increased risk of tumor recurrence. Radiotherapy waitingrntime at TASH oncology center is unknown and expected to be more than a year. All high risk postrnmastectomypatients will be registered and wait for adjuvant radiotherapy. Benefit of givingrndelayed adjuvant chest wall irradiation is unknown. Despite our routine clinical practice, suchrntreatment delay should be evaluated.rnObjective – The main objective of study was to assess the clinical benefit of delayed adjuvantrnradiotherapy delivery after 1 year of post mastectomy.rnMethods – Institutional based retrospective cross-sectional used to assess tumor control raternamong post mastectomy breast cancer patients registered at TASH radiotherapy center for thernindication of adjuvant chest wall irradiation.rnResult- In 2016 at TASH radiotherapy center, total of 274 high risk post mastectomy patientsrnhad registered for adjuvant chest wall irradiation. At 1year of post mastectomy, amongrnradiotherapy registered 67.5%(185) patients had stable disease. Nearly 38.6% (106)patientsrndid not take adjuvant radiotherapy and 28.8% (79) patients had took sequentially adjuvantrnchemotherapy and radiotherapy. The mean radiotherapy waiting time was 8.8±1.4monthsrn.Among those who took delayed adjuvant radiotherapy, the mean post mastectomy adjuvantrnradiotherapy delivery time was 10.4 ±1.9 months. At 4 years follow up,62.7%(116) patientsrnare alive, 27.6%(52) had died and 9.7%(17) had unknown status. Tumor recurrenceconfirmedrnin 28.6% (53) patients. Among sub-groups, 34.1% (27) and 24.5% (26) patients had tumorrnrecurrence among those who took and did not tookdelayed adjuvant radiotherapy respectively.rnAdjuvant radiotherapy was not found to be association with tumor control (COR=1.5, 95%rnCI=0.83-3.03, P-0.16). On multivariate analysis only advanced nodal tumor showed staticallyrnsignificant for tumor recurrence. N2 and N3 stage patients were found to be 3.8 and 4.3 times morelikely to develop recurrence as compared to Nx& N1 patients respectively (AOR, 3.86, CI 1.72-8.65,rnAOR 4.34, CI 1.54-12.26)rnConclusion- Delayed adjuvant radiotherapy after median 10.4 months of post mastectomy did notrnassociate with improved tumor control. According to our finding, most unnecessary delivery ofrndelayed adjuvant radiotherapy can be omitted and delayed adjuvant chest wall irradiation shouldrnbe given among patients having one of those poor prognostic factors age less than 55 years orrnadvanced nodal tumor disease (N2 and N3).rnRecommendations– Radiotherapy waiting time at TASH oncology center can be improvedrnthrough avoiding unnecessary delayed radiotherapy delivery among breast cancer patients. sincernTASH oncology center is the only center having single cobalt-60 machines for the whole country,rnthe available energy source should be used effectively and efficiently without compromisingrntreatment quality.

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