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• W2528127965 abstract "Hypofractionated whole breast irradiation (WBI) confers equal local control and cosmesis as compared to standard-fractionated treatment. Trials using hypofractionated WBI did not utilize a tumor bed (TB) boost, or utilized one with standard fractionation. We performed a retrospective analysis to determine acute and late outcomes following hypofractionated WBI and boost. We examined records of patients treated with hypofractionated WBI and hypofractionated TB boost after lumpectomy for stage 0-II breast cancer. Local control, toxicity, and cosmetic outcome were evaluated. Acute skin toxicity was scored according to RTOG criteria, late toxicity ≥1 month after radiation therapy (RT), according to CTCAE v.4.03, and cosmetic outcome, based on the Harvard Breast Cosmesis Scale. Patient, tumor, and treatment characteristics were evaluated including excision volume, surgical technique and complications, chemotherapy and endocrine therapy administration, and RT dose, fractionation, and technique. Univariate analyses were performed with chi-squared tests using analytics software. One hundred sixty-six patients received hypofractionated WBI and boost from 2010 and 2015. Median follow-up was 15 months (1 – 62 mos). Median age was 65 years (44 – 91 yrs). Patient stage was 0, I, and II in 23.5%, 67.5%, and 9.0%, respectively. Median tumor size was 1.2 cm (0.2 – 7.8 cm). Median initial excision volume was 65.2cm3 (15.1 – 962.9 cm3). 17% had oncoplastic closures. 14% had re-excision for positive margins. Postoperative complications included 21.1% palpable seroma, 2.4% wound infection, and 1.2% hematoma. 10% received chemotherapy, and 64%, endocrine therapy. All patients received hypofractionated WBI with 42.5 Gy in 16 fractions (fx). Median TB boost fractional dose was 266 cGy (240 – 266 cGy) and median number of boost fx was 3 (2–4 fx). 64% received 266 cGy/fx for 3 fx. TB boost was given via en face electrons, high dose-rate non-invasive breast brachytherapy (NIBB), electrons and NIBB, and mini-tangents in 64.5%, 21.1%, 12.7%, and 1.2%, respectively. Acute skin reaction was grade 1 in 60.8% and grade 2 in 32.5%. Moist desquamation developed in 7.2%. No treatment breaks for acute toxicity were needed. Late toxicities included 19.3% post-surgery/radiation volume loss, 3.6% breast edema, 1.2% telangiectasia, 1.8% symptomatic fat necrosis, and 0.6% arm lymphedema. 15% experienced subcutaneous fibrosis; 13.2%, 1.2%, and 0.6% were grade 1, 2, and 3, respectively. 93.4% achieved good/excellent cosmesis. There were no local recurrences. Postoperative complications (relative risk 3.2, P<0.01) correlated with late toxicity, but not closure type, excision volume, re-excision, boost technique/dose/fractionation. No factors correlated with poor cosmesis. Hypofractionated TB boost is well-tolerated with a low rate of toxicity and high rate of good-to-excellent cosmesis. When boost is planned as part of hypofractionated WBI, a hypofractionated boost should be considered." @default.
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• W2528127965 date "2016-10-01" @default.
• W2528127965 modified "2023-10-14" @default.
• W2528127965 title "Analysis of Acute and Late Outcomes Using Hypofractionated Tumor Bed Boost Following Hypofractionated Whole-Breast Irradiation for Early-Stage Breast Cancer" @default.
• W2528127965 doi "https://doi.org/10.1016/j.ijrobp.2016.06.676" @default.
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