Preoperative Radiation Boost Results in Low Rates of Re-excision and Reduced Locoregional Treatment Time in Breast...

We conducted a prospective, phase II trial in which a radiation tumor bed boost was delivered preoperatively instead of the standard postoperative approach for breast cancer patients. We hypothesized that a preoperative boost would result in a lower rate of re-excision and a shorter duration of locoregional therapy compared with a postoperative boost.

Patients in this trial (NCT04871516) received a boost of 13.32 Gy in 4 fractions, followed by lumpectomy and whole-breast radiotherapy of 36.63 Gy in 11 fractions. The re-excision rate in this trial was compared with the literature-reported rate and with a cohort of contemporary patients at our institution. The time from initial diagnostic biopsy to completion of radiotherapy was compared with the same contemporary cohort and with patients treated in a previous prospective trial at our institution (NCT00909909) with the same fractionation scheme.

Among 89 patients who were included, three (3.4%) required re-excision for inadequate surgical margins. This rate was lower than the literature-reported rate of 17.2% (p = 0.0005) and was also lower than the contemporary cohort (13.48%, p = 0.015). The median locoregional treatment time was 109 days (42-258) in this trial, which was shorter than the median treatment time in both the previous trial [122 days (62-311), p = 0.0002] and the contemporary cohort [126 days (74-278), p ≤ 0.0001].

Lower re-excision rates and shorter time from initial diagnosis to completion of radiotherapy, as observed in this phase II trial, may reduce treatment costs and risk of wound complications, improve treatment experience, and enable earlier initiation of systemic therapy.