Hypofractionated Whole-Breast Irradiation in Large-Breasted Women-Is There a Dosimetric Predictor for Acute Skin Toxicities?

International Journal of Radiation Oncology, Biology, Physics
Ankur K PatelSushil Beriwal

Abstract

Underutilization of hypofractionated whole-breast irradiation (HF-WBI) in large-breasted women may be partially explained by concerns about dose heterogeneity. Although modern planning may mitigate this issue, validated dosimetric guidelines are lacking. Our clinical pathway mandates hypofractionation, guided by institutional dosimetric criteria for plan evaluation. We examined acute radiation dermatitis rates with HF-WBI in large-breasted patients when our guidelines are followed and evaluated factors predictive for dermatitis. Patients with whole-breast clinical target volumes (WB-CTV) of ≥1000 cm3 treated with HF-WBI were reviewed. WB-CTV V105, V107, and V110 were assessed. Our guidelines recommend limiting V105 to <10% to 15% and V110 to 0%. The highest grade of acute dermatitis was recorded. Potential clinical and dosimetric predictors of dermatitis were analyzed using logistic regression. From 2012 to 2017, 505 breasts in 502 patients were treated with HF-WBI. The median WB-CTV was 1261.3 cm3 (interquartile range [IQR], 1115.3-1510.0). Most plans (99%) delivered 42.56 Gy in 16 fractions. A cavity boost of 10 Gy in 4 fractions was delivered in 99% of plans. Electrons were used in 69% of boost plans. Three-dimensional field...Continue Reading

Citations

Sep 19, 2020·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Abram Recht
Jul 13, 2021·JCO Precision Oncology·Leslie A ModlinLior Z Braunstein
Aug 4, 2021·Medical Oncology·Riccardo Ray ColciagoMaria Carmen De Santis
Oct 12, 2021·International Journal of Radiation Oncology, Biology, Physics·Reshma JagsiUNKNOWN Michigan Radiation Oncology Quality Consortium

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