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Published on: July 3, 2014
Cumulative Risk of Cosmetic Worsening Following Ultrahypofractionated Whole Breast Radiation Therapy With
Tabassum Wadasadawala1, Naseera Syeda1, Shraddha Kenekar2
1Breast Cancer Disease Management Group, Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India.
Purpose:
Randomized trials have shown that ultrahypofractionated radiation therapy (uHFRT) is a safe alternative to moderately hypofractionated or conventional breast radiation therapy. However, its safety in patients requiring a tumor bed boost cannot be firmly established, as none of the patients in the FAST trial and only a quarter of the patients in the FAST-FORWARD trial were offered a tumor bed boost. We aimed to report the real-world experience of cosmetic outcomes after whole breast irradiation with uHFRT and a simultaneous integrated boost (SIB).
Methods And Materials:
The study population consisted of 354 breast cancer patients treated with uHFRT from 2020 to 2022. All patients received SIB either with electrons (n = 207) or photons (n = 147). The SIB dose was 33 Gy and 32 Gy for the FAST (n = 74) and FAST-FORWARD (n = 280) protocols, respectively. Cosmesis was assessed subjectively by the physicians and the patients and objectively by the BCCT.core software. The worsening of breast cosmesis was defined as a shift in the score from any lower to a higher category on a 4-point scale, ie, excellent (0), good (1), fair (3), and poor (4).
Results:
The median follow-up time of the cohort was 31.31 months. As per the physicians' ratings, cosmetic deterioration at 1 year was 17% (13%, 21%), which doubled to 34% (29%, 39%) at 2 years. Patient-rated worsening was 9% (6.3%, 12%) at 1 year and 15% (12%, 19%) at 2 years. Similarly, the BCCT.core rating also showed temporal worsening: 17% (13%, 22%) at 1 year and 33% (28%, 38%) at 2 years. Multivariate analysis showed that higher body mass index, postmenopausal status, women with larger breast volumes, oncoplastic surgery, regional nodal irradiation, and the FAST-FORWARD protocol were factors associated with a higher risk of cosmetic worsening.
Conclusions:
We observed that uHFRT with SIB was associated with an early cosmetic deterioration that progressively worsened over time. These real-world findings offer valuable insights to support informed clinical decision-making.
