Abstract
<h3>Purpose/Objective(s)</h3> To share the experience of planning, dosimetric evaluation and delivery of ultra-hypofractionated (fast forward-FF) versus hypofractionated (HF) radiotherapy in breast cancers treated at our center. <h3>Materials/Methods</h3> 60 patients (average age 44 years- range 32-65 years) of early [T1, T2N0] breast cancer (BC) treated between October 2020 and October 2021 were included. Plans of 15 patients of left BC by FF, left BC by HF, right BC by FF and right BC by HF were evaluated in terms of coverage and organs at risk (OAR) constraints. Patients were planned by field within field [FIF] planning for phase I (42.5 Gy/16# for HF and 26 Gy/5# for FF). Boost plans were generated by FIF/electron/conformal planning to a dose of 10-16 Gy @ 2 Gy/fraction. Deep inspiratory breath hold (DIBH) was used for left sided BC patients who were able to hold breath. PTV coverage goal was V95 more than or equal to 95%, V105 <7%, V107 < 2%. Constraints for FF were – lung V8<15%, heart V1.5<30%, V7<5%. Constraints for HF plans were – lung V20<20%, heart avg <3 Gy. 15 right sided BC patients were treated with FF and 15 by HF plans. For left sided BC, plans were generated for dosimetric comparison between FF and HF plans, but all patients were treated by HF plans. <h3>Results</h3> For left sided BC cases, high heart dose was seen in those with more heart volume, precordial location of boost volume and patients unable to do DIBH. All patients treated by FF had grade I skin reaction and 1/15 had wet desquamation in inframammary fold. Among patients treated by HF, majority patients had dry desquamation, 3/45 had wet desquamation in folds. Edema developed in FF by 2-3<sup>rd</sup> fraction and by 7-9<sup>th</sup> fraction in HF. Edema was milder in HF. The edema and skin changes resolved in 2-3 weeks. At 3 and 6 months, mild skin discoloration and minimal induration at post op site was seen which was similar in those treated by FF and HF. <h3>Conclusion</h3> Adequate coverage and OAR constraints can be met for FF as for HF plans. Radiation dermatitis is milder in FF arm and the edema is milder in the HF arm. Radiation of early breast cancer by FF is executable at independent centers with diligent planning with tight constraints and precise delivery.
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