Ductal carcinoma in situ (DCIS) breast cancer treated with 3-week accelerated hypofractionated whole-breast radiation therapy and concomitant boost

Abstract

Introduction In patients with ductal carcinoma in situ (DCIS), the clinical outcomes with hypofractionated (HF) whole-breast radiation (WBRT), as well as the role of lumpectomy boost, continue to be evaluated. In this paper, we report our experience on DCIS patients treated with HF WBRT with concomitant boost (CB). Methods Early-stage (DCIS, stages I and II) breast cancer patients were treated on an IRB-approved prospective single-arm study with HF WBRT and CB. This study includes only the DCIS subset of patients prescribed a dose of 40.5 Gy × 2.7 Gy per fraction to WB with CB of 4.5 Gy × 0.3G y per fraction over 15 fractions. A total of 107 breasts in 104 patients met the study criteria. Results All patients underwent lumpectomy with negative margins. Median age was 59 years. DCIS nuclear grade distribution was 9.3% grade 1, 50.5% grade 2, and 37.4% grade 3. Majority (86%) were ER positive. 41.1% received endocrine therapy. With median follow-up of 74 months (range, 12-158), 5-year actuarial overall survival was 97.2%. At the time of this report, no patient has experienced local relapse. The CTCAE grades 1 and 2 acute skin toxicity was 66.4% and 3.7%, respectively. No patients experienced grade 3 or higher skin toxicity, breast pain, and fatigue. Conclusion The HF schedule with CB in DCIS patients is well tolerated and associated with excellent clinical outcomes. This schedule affords the benefit of delivering higher dose to the lumpectomy site without protracting overall treatment time.

Feasibility of commercially available underwear during radiation therapy for breast cancer: build-up and surface dose measurements

“…A shorter fractionation schedule of 3-4 weeks is also acceptable. 2,3 When patients receive radiation therapy, it is necessary to take off their underwear to avoid build-up effects that increase the skin dose, to ensure the reproducibility of the patient's position and to check skin tattoos. However, it is a mental burden for female patients to take off their underwear at every fraction of radiation therapy.…”