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Hypofractionated whole-breast radiation therapy: does breast size matter?
Raquibul Hannan1, Reid F Thompson, Yu Chen
1Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9183, USA. Raquibul.Hannan@gmail.com
Summary
Intensity-modulated radiation therapy (IMRT) effectively delivers hypofractionated radiation therapy for whole-breast treatment, regardless of breast size. While larger breast size increases heart and skin dose, IMRT remains a safe and effective option for all patients.
Area of Science:
- Radiation Oncology
- Medical Physics
- Clinical Oncology
Background:
- Hypofractionated radiation therapy is an evolving treatment strategy.
- Intensity-modulated radiation therapy (IMRT) offers precise dose delivery.
- The impact of breast size on treatment outcomes requires further investigation.
Purpose of the Study:
- To assess the influence of breast size on dose-volume histogram (DVH) parameters.
- To evaluate clinical toxicity in patients undergoing whole-breast hypofractionated IMRT.
- To compare outcomes between large-breasted and small-breasted patient cohorts.
Main Methods:
- Retrospective analysis of patients treated between 2005-2009.
- Categorization into large-breasted (>25 cm chest wall separation or >1500 cm3 PTV) and small-breasted groups.
- Whole-breast hypofractionated IMRT (42.4 Gy/16 fractions) with boost (9.6 Gy/4 fractions).
Main Results:
- Planning target volume (PTV) coverage was consistent across breast sizes.
- Increasing breast size correlated with higher heart and maximum skin doses.
- Acute grade 2 skin toxicity was more frequent in large-breasted patients (28% vs 12%).
Conclusions:
- IMRT ensures adequate PTV coverage and organ-at-risk sparing irrespective of breast size.
- Despite increased heart and skin doses in larger breasts, IMRT remains within institutional limits.
- Hypofractionated IMRT is a suitable treatment for large-breasted patients.
