Accelerated Hypofractionated Whole-Breast Irradiation With Concomitant Daily Boost in Early Breast Cancer

Abstract

The aim of this study is to evaluate the feasibility and the related toxicity of hypofractionated whole-breast irradiation with a concomitant daily boost in early breast cancer women not eligible for accelerated partial-breast irradiation. Twenty-seven patients received 46 Gy to the whole breast in 20 fractions/4 weeks with 2.3 Gy/fraction plus an additional concomitant daily boost of 0.4 Gy to the tumor bed, giving a total dose of 54 Gy (EQD2=60 Gy). The cosmetic outcome was assessed according to the European Organization for Research and Treatment of Cancer and Radiation Therapy Oncology Group grading system. Three months after the end of radiotherapy, 59.2% and 40.7% of patients showed grade 0 skin toxicity and grade 1 skin toxicity, respectively. After 6 months, 70.4% and 29.6% of patients showed grade 0 and grade 1 skin toxicity. After 1 year, grade 0 skin toxicity was found in 77.7% of the patients and grade 1 skin toxicity in 22.2% of the patients. After 18 months, grade 0 skin toxicity was found in 92.6% and grade 1 skin toxicity in 7.4% of the patients. After a median follow-up of 24 months, all patients showed excellent cosmetic results with minimal breast edema and minimal skin changes. There have been no local relapses to date. The accelerated hypofractionated schedule with a concomitant boost appears to be an acceptable alternative to the traditional longer schedule, with low local toxicity and excellent to good short-term cosmetic results, although a much longer follow-up is needed to assess the local control rate.