Comparison of Risk of Ipsilateral Breast Event After Lumpectomy for Ductal Carcinoma In Situ, As Estimated by Breast Radiation Oncologists, Van Nuys Prognostic Index, Memorial Sloan Kettering Cancer Center DCIS Nomogram, and the 12-gene DCIS Score

Abstract

Quality Consortium (MROQC), a statewide assessment of breast cancer patients undergoing radiation therapy and crude rates were used for comparisons. Results: For left sided cancers, mean heart dose was 3.09 Gy. The use of a breast cup resulted in mean V20 for lung of 5.6% and V5 of 11%. Mean dose to the contralateral breast was 3.29 Gy. Twenty patients (42.5%) experienced grade 2 skin toxicity; one patient (2.1%) experienced a grade 3 skin toxicity. Moist desquamation rates: 44.7% compared to 45.5% MROQC. Moist desquamation for patients with a BMI >35 was 52.2% vs 42.8% MROQC. For a breast volume >1550cc, moist desquamation was seen in 48.6% vs 45.5% MROQC. Conclusion: Our results indicate that use of the breast cup can allow for improved dose homogeneity with similar acute toxicities as compared with patients treated without the cup while minimizing the dose to the heart and lungs. Our clinical experience shows that breast cups can be used with ease, and allow for good setup reproducibility. It appears that the slight increase in moist desquamation was associated with increased BMI. In conclusion, we recommend that use of a breast cup be considered in appropriately selected patients with large or pendulous breasts. Author Disclosure: P.R. Sevak: None. K. Aldridge: None. C. Fraser: None. C.K. Glide-Hurst: None. E.M. Walker: ACR appropriateness criteria expert panel member; ACR. RTOG Foundation advisory board member; RTOG. Breast working group; NRG. health disparities working group member; NRG. Institutional PI for NRG; NRG.