1. Implementation of 26 Gy in five fractions over 1 week adjuvant radiotherapy for breast cancer: Prospective report of acute skin toxicity and consideration of resource implications.
- Author
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Nugent, K., Quinlan, E., Cleary, S., O'Driscoll, H., Rohan, C., Trousdell, J., Williams, J., Dunne, M., McArdle, O, and Duane, F.K.
- Subjects
ACUTE toxicity testing ,BREAST cancer ,CANCER radiotherapy ,TELEMEDICINE - Abstract
In March 2020, a 1-week adjuvant breast radiotherapy schedule, 26 Gy in 5 fractions, was adopted to reduce the risk of COVID19 for staff and patients. This study quantifies acute toxicity rates and the effect on linac capacity. This is a report of consecutive patients receiving ultrafractionated breast radiotherapy (± sequential boost) Mar–Aug 2020. Virtual consultations assessed acute skin toxicity during treatment and weeks 1, 2, 3 and 4 post treatment using CTCAE V5 scoring criteria. The number of linac minutes saved was estimated accounting for boost and DIBH use. In total, 128/135 (95%) patients, including 31/33 boost patients, completed at least 3/5 assessments. 0/128 (0%) reported moist desquamation not confined to skin folds or minor bleeding (Grade 3), 41/128 (32%) reported brisk erythema, moist desquamation confined to skin folds or breast swelling (Grade 2), 62/128 (48%) reported faint erythema or dry desquamation (Grade 1) as their worst skin toxicity, with the remaining 20% reporting no skin toxicity. The highest prevalence of grade 2 toxicity occurred week 1 following treatment (20%), reducing to 3% by week 4. There was no difference in toxicity between those who received a boost versus not (p = 1.00). Delivering this schedule to 135 patients over six months saved 21,300 linac minutes and 1485 hospital visits compared to a 3-week schedule. Rapidly implementing ultrahypofractionated breast radiotherapy is feasible and acute toxicity rates are acceptable even when followed by boost. • It is feasible and safe to rapidly implement ultrahypofractionated breast RT. • 26 Gy in 5 fractions (± sequential boost) leads to G0-2 acute skin toxicity. • G3 acute skin toxicity is usually not observed with ultrahypofractionated breast RT. • Ultrahypofractionation does not lead to excess toxicity when breast volume is large. • Ultrahypofractionation saved 6300 LINAC minutes over 6 months (135 patients). [ABSTRACT FROM AUTHOR]
- Published
- 2023
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