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Dosimetric Correlates of Acute Toxicities for Moderate Hypofractionated Whole-Breast Irradiation: Implications for
Vishruta A Dumane1, Juliana Runnels1, Mira Cohen1
1Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
Purpose:
ASTRO's 2018 guidelines for hypofractionated whole-breast irradiation (HF WBI) recommend limiting high-dose regions to improve dose homogeneity and minimize toxicity. However, correlation of these guidelines with clinical outcomes remains limited. This study investigates the relationship between dose-volume parameters and acute toxicities including pain, erythema, edema and moist desquamation in patients treated with HF WBI in accordance with ASTRO 2018 guidelines.
Methods And Materials:
We retrospectively reviewed patients treated from 2018 to 2023 with HF WBI (42.56 Gy in 16 fractions or 40.05 Gy in 15 fractions) between 2018 and 2023 using 3-dimensional conformal field-in-field planning. All plans adhered to ASTRO constraints (V105% < 200 cm3; V107% < 2 cm3). Acute toxicities were prospectively scored using the Common Terminology Criteria for Adverse Events V5.0 at weekly on-treatment visits (OTVs) and at 1 month follow-up. Logistic regression analyses identified predictors of grade ≥ 2 toxicities.
Results:
600 patients were treated with HF WBI. Of those patients, 82.3% received a dose of 42.56 Gy in 16 fractions, whereas the remaining received 40.05 Gy in 15 fractions. Three-dimensional field-in-field planning was used in all patients and 73.7% received a boost. Moderate-to-severe pain (grade ≥ 2) occurred in 29.7% of patients during treatment despite compliance with ASTRO guidelines. In contrast, grade ≥ 2 erythema, edema, and moist desquamation were observed in <5% of patients. Multivariate analysis identified V105 % (cm3) ≥ 50 cm3, V105 % (%) ≥ 5% and body mass index ≥ 30 as independent predictors of grade ≥ 2 pain, which decreased by 30% when V105 % (cm3) < 50 cm3 and by 18.5% when V105 % (%) < 5%.
Conclusions:
Although skin related toxicities were infrequent and largely resolved by 1 month, pain remained a prevalent side effect of HF WBI. These findings suggest that ASTRO's current V105% thresholds may be too permissive for pain mitigation. Stricter limits of V105% (cm3) < 50 cm3 and V105% (%) < 5% may better protect patients from treatment-related discomfort and warrant consideration in future guideline updates.
